[{"gpi":"6770202010D520","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"CGRP Receptor Antagonists - Monocolonal Antibodies","drug_name":"Aimovig (140 MG Dose) Solution Auto-Injector 70 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6770202010D540","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"CGRP Receptor Antagonists - Monocolonal Antibodies","drug_name":"Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"140","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6770202010D520","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"CGRP Receptor Antagonists - Monocolonal Antibodies","drug_name":"Aimovig Solution Auto-Injector 70 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97401010106200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Condoms - Male","drug_name":"Aimsco Lubricated","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21409902120330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Hormonal and Related Agent Combinations","drug_name":"Akeega Tablet 100-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21409902120320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Hormonal and Related Agent Combinations","drug_name":"Akeega Tablet 50-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"50309902290120","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetic Combinations","drug_name":"Akynzeo Capsule 300-0.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"3","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300-0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000002000320","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Albendazole Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Alka-Seltzer Plus Allergy Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025006810","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Alkindi Sprinkle Capsule Sprinkle 0.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips Plus 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips Plus 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips Plus 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips Plus 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"1st Tier Unifine Pentips Plus 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"55104020003710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"3 Day Vaginal Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"3232A Infant Formula Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"7 Day Vaginal Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"8 Hour Pain Reliever Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12105005102020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Purines","drug_name":"Abacavir Sulfate Solution 20 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12105005100320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Purines","drug_name":"Abacavir Sulfate Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902200340","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Abacavir Sulfate-lamiVUDine Tablet 600-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903200320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Abacavir-lamiVUDine-Zidovudine Tablet 300-150-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300-150-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21406010200320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Androgen Biosynthesis Inhibitors","drug_name":"Abiraterone Acetate Tablet 250 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21406010200330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Androgen Biosynthesis Inhibitors","drug_name":"Abiraterone Acetate Tablet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"17100072202120","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Abrysvo Solution Reconstituted 120 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100085002150","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"ACAM2000 Solution Reconstituted Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62802010200620","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Alcohol Deterrents","drug_name":"Acamprosate Calcium Tablet Delayed Release 333 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"333","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27500010000340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Alpha-Glucosidase Inhibitors","drug_name":"Acarbose Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27500010000310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Alpha-Glucosidase Inhibitors","drug_name":"Acarbose Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27500010000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Alpha-Glucosidase Inhibitors","drug_name":"Acarbose Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200010100105","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Acebutolol HCl Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200010100110","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Acebutolol HCl Capsule 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Acerflex Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Childrens Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen ER Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000914","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Extra Strength Liquid 500 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010002010","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Solution 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010002010","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Solution 325 MG/10.15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG/10.15ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010002010","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Solution 650 MG/20.3ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG/20.3ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010005205","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Suppository 120 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010005220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Suppository 650 MG Rectal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Acetaminophen Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65991002052020","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Codeine Combinations","drug_name":"Acetaminophen-Codeine Solution 120-12 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120-12","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"M","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991002052020","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Codeine Combinations","drug_name":"Acetaminophen-Codeine Solution 300-30 MG/12.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300-30","strength_unit_of_measure":"MG/12.5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"M","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991002050310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Codeine Combinations","drug_name":"Acetaminophen-Codeine Tablet 300-15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300-15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991002050315","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Codeine Combinations","drug_name":"Acetaminophen-Codeine Tablet 300-30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300-30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991002050320","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Codeine Combinations","drug_name":"Acetaminophen-Codeine Tablet 300-60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300-60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"37100010006920","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Carbonic Anhydrase Inhibitors","drug_name":"acetaZOLAMIDE ER Capsule Extended Release 12 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37100010000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Carbonic Anhydrase Inhibitors","drug_name":"acetaZOLAMIDE Tablet 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37100010000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Carbonic Anhydrase Inhibitors","drug_name":"acetaZOLAMIDE Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56700040002005","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Genitourinary Irrigants","drug_name":"Acetic Acid SOLUTION 0.25 % IRRIGATION","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"%","route":"Irrigation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87400010102010","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Agents - Miscellaneous","drug_name":"Acetic Acid Solution 2 % Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Otic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"43300010002003","therapeutic_category":"COUGH/COLD/ALLERGY (Medications to treat cough, cold or allergy symptoms)","therapeutic_class":"Mucolytics","drug_name":"Acetylcysteine Solution 10 % Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"%","route":"Inhalation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"43300010002005","therapeutic_category":"COUGH/COLD/ALLERGY (Medications to treat cough, cold or allergy symptoms)","therapeutic_class":"Mucolytics","drug_name":"Acetylcysteine Solution 20 % Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"%","route":"Inhalation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002151809","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"Acid Gone Suspension 95-358 MG/15ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"95-358","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002150520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"Acid Gone Tablet Chewable 160-105 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160-105","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49200020100305","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Acid Reducer Maximum Strength Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200030000310","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Acid Reducer Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Acidophilus Probiotic Formula Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Acidophilus Probiotic Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Acidophilus Probiotic Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300025000500","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Acidophilus Tablet Chewable Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Acidophilus Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Acidophilus/L-Sporogenes Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90250510000110","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Acitretin Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90250510000115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Acitretin Capsule 17.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"17.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90250510000125","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Acitretin Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050010000910","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Acne Foaming Wash Liquid 10 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200030102100","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"ActHIB SOLUTION RECONSTITUTED Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93000010100900","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes and Specific Antagonists","drug_name":"Actidose-Aqua Liquid 15 GM/72ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"GM/72ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93000010100900","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes and Specific Antagonists","drug_name":"Actidose-Aqua Liquid 25 GM/120ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"GM/120ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93000010100900","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes and Specific Antagonists","drug_name":"Actidose-Aqua Liquid 50 GM/240ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"GM/240ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21700060702020","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastics Misc.","drug_name":"Actimmune Solution 100 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ACTIMMUNE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93000010100110","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes and Specific Antagonists","drug_name":"Activated Vegetable Charcoal Capsule 260 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"260","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78516014000120","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"Active OB Capsule 20-1-320 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-1-320","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12405010000110","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Purine Analogues","drug_name":"Acyclovir Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12405010102030","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Purine Analogues","drug_name":"Acyclovir Sodium Solution 50 MG/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12405010001810","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Purine Analogues","drug_name":"Acyclovir Suspension 200 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12405010000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Purine Analogues","drug_name":"Acyclovir Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12405010000330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Purine Analogues","drug_name":"Acyclovir Tablet 800 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990003221815","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Adacel Suspension 5-2-15.5 LF-MCG/0.5 Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5-2-15.5","strength_unit_of_measure":"LF-MCG/0.5","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1899000322E615","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Adacel Suspension Prefilled Syringe 5-2-15.5 LF-MCG/0.5 Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5-2-15.5","strength_unit_of_measure":"LF-MCG/0.5","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"20000050002025","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Biologicals Misc","drug_name":"Adagen Solution 250 UNIT/ML Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ADAGEN"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"UNIT/ML","route":"Intramuscular","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001504D515","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Adalimumab-adaz Solution Auto-Injector 40 MG/0.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.80","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001504D540","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Adalimumab-adaz Solution Auto-Injector 80 MG/0.8ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.60","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001504E515","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Adalimumab-adaz Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.80","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001535F520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Adalimumab-fkjp (2 Pen) Auto-Injector Kit 40 MG/0.8ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Auto-Injector Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001535F810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 20 MG/0.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001535F820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Adalimumab-fkjp (2 Syringe) Prefilled Syringe Kit 40 MG/0.8ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050003004010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Adapalene Gel 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050003004030","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Adapalene Gel 0.3 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90059902034020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Combinations","drug_name":"Adapalene-Benzoyl Peroxide Gel 0.1-2.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1-2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027308045D530","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Adbry Solution Auto-Injector 300 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027308045E520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Adbry Solution Prefilled Syringe 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12352015100320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis B Agents","drug_name":"Adefovir Dipivoxil Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40134050000310","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)","drug_name":"Adempas Tablet 0.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ADEMPAS (riociguat)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40134050000320","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)","drug_name":"Adempas Tablet 1 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ADEMPAS (riociguat)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40134050000330","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)","drug_name":"Adempas Tablet 1.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ADEMPAS (riociguat)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40134050000340","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)","drug_name":"Adempas Tablet 2 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ADEMPAS (riociguat)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40134050000350","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulm Hyperten-Soluble Guanylate Cyclase Stimulator (sGC)","drug_name":"Adempas Tablet 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ADEMPAS (riociguat)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2710400500D222","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Admelog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104005002022","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Admelog Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Advantage Infant Formula/Iron Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"66100020000303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Advil Junior Strength Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Advocate Insulin Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Advocate Insulin Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Mini Chamber Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber MV","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Plus Flo-Vu","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Plus Flo-Vu Large","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Plus Flo-Vu Medium","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Plus Flo-Vu Small","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Plus Flow VU","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber w/FLOWSIGnal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Z-Stat Plus","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Z-Stat Plus Chambr","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Z-Stat Plus/Large","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Z-Stat Plus/Medium","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"AeroChamber Z-Stat Plus/Small","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532530007310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - mTOR Kinase Inhibitors","drug_name":"Afinitor Disperz Tablet Soluble 2 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532530007320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - mTOR Kinase Inhibitors","drug_name":"Afinitor Disperz Tablet Soluble 3 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532530007340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - mTOR Kinase Inhibitors","drug_name":"Afinitor Disperz Tablet Soluble 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002021E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Afluria Preservative Free Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100020251800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Afluria Quadrivalent Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002025E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Afluria Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100020201800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Afluria Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44201010103410","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Albuterol Sulfate HFA Aerosol Solution 108 (90 Base) MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"108 (90 Base)","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"Y","prescriber_note":"quantity limit of 2 inhalers per 30 days","protected_class":false,"emergency_fill":false},{"gpi":"44201010102515","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Albuterol Sulfate Nebulization Solution (2.5 MG/3ML) 0.083% Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"(2.5 MG/3ML)","strength_unit_of_measure":"0.083%","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201010102520","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Albuterol Sulfate Nebulization Solution (5 MG/ML) 0.5% Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"(5 MG/ML)","strength_unit_of_measure":"0.5%","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201010102555","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Albuterol Sulfate Nebulization Solution 0.63 MG/3ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.63","strength_unit_of_measure":"MG/3ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201010102560","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Albuterol Sulfate Nebulization Solution 1.25 MG/3ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MG/3ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201010101205","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Albuterol Sulfate Syrup 2 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550005103710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Alclometasone Dipropionate Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550005104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Alclometasone Dipropionate Ointment 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Alcohol Pads Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Alcohol Prep Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Alcohol Swabs Pad","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Alcohol Swabs Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21530507100120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - ALK Inhibitors","drug_name":"Alecensa Capsule 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30042010100310","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Bisphosphonates","drug_name":"Alendronate Sodium Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30042010100335","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Bisphosphonates","drug_name":"Alendronate Sodium Tablet 35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30042010100305","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Bisphosphonates","drug_name":"Alendronate Sodium Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30042010100370","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Bisphosphonates","drug_name":"Alendronate Sodium Tablet 70 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"AlerTab Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Alfamino Infant Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Alfamino Junior Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56852010107530","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Alpha 1-Adrenoceptor Antagonists","drug_name":"Alfuzosin HCl ER Tablet Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Alimentum Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Alimentum Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"16400060001920","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Antiprotozoal Agents","drug_name":"Alinia Suspension Reconstituted 100 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025006815","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Alkindi Sprinkle Capsule Sprinkle 1 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025006820","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Alkindi Sprinkle Capsule Sprinkle 2 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025006830","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Alkindi Sprinkle Capsule Sprinkle 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"All Day Pain Relief Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"All Day Relief Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100105","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Allergy Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100920","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Allergy Childrens Liquid 12.5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Allergy Medication Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100105","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Allergy Relief Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Allergy Relief Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Allergy Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"68000010000305","therapeutic_category":"GOUT AGENTS (Medications to treat gout)","therapeutic_class":"Gout Agents","drug_name":"Allopurinol Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"FEBUXOSTAT","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"68000010000310","therapeutic_category":"GOUT AGENTS (Medications to treat gout)","therapeutic_class":"Gout Agents","drug_name":"Allopurinol Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"FEBUXOSTAT","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406010100330","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Almotriptan Malate Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406010100320","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Almotriptan Malate Tablet 6.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27550010100320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"Alogliptin Benzoate Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27550010100330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"Alogliptin Benzoate Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27550010100310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"Alogliptin Benzoate Tablet 6.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27992502100330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Alogliptin-metFORMIN HCl Tablet 12.5-1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27992502100320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Alogliptin-metFORMIN HCl Tablet 12.5-500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Alophen Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Alsoy Soy Formula Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Alsoy Soy Formula Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002400310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Altavera Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21530510000365","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - ALK Inhibitors","drug_name":"Alunbrig Tablet 180 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21530510000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - ALK Inhibitors","drug_name":"Alunbrig Tablet 30 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21530510000350","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - ALK Inhibitors","drug_name":"Alunbrig Tablet 90 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153051000B720","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - ALK Inhibitors","drug_name":"Alunbrig Tablet Therapy Pack 90 & 180 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"90 & 180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"82405030050320","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Alvaiz Tablet 18 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030050330","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Alvaiz Tablet 36 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"36","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030050340","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Alvaiz Tablet 54 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"54","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030050310","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Alvaiz Tablet 9 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45309903850325","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agent - Combinations","drug_name":"Alyftrek Tablet 10-50-125 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10-50-125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45309903850310","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agent - Combinations","drug_name":"Alyftrek Tablet 4-20-50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"84","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4-20-50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120305","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Amabelz Tablet 0.5-0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5-0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120310","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Amabelz Tablet 1-0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200010100105","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Amantadine HCl Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200010102005","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Amantadine HCl Solution 50 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200010101205","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Amantadine HCl Syrup 50 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200010100310","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Amantadine HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40160007000320","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulmonary Hypertension - Endothelin Receptor Antagonists","drug_name":"Ambrisentan Tablet 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40160007000310","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulmonary Hypertension - Endothelin Receptor Antagonists","drug_name":"Ambrisentan Tablet 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"07000010102013","therapeutic_category":"AMINOGLYCOSIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminoglycosides","drug_name":"Amikacin Sulfate Solution 1 GM/4ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM/4ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"07000010102011","therapeutic_category":"AMINOGLYCOSIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminoglycosides","drug_name":"Amikacin Sulfate Solution 500 MG/2ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/2ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"37500010100305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Potassium Sparing Diuretics","drug_name":"aMILoride HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37990002100310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Diuretic Combinations","drug_name":"aMILoride-hydroCHLOROthiazide Tablet 5-50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"84100010002060","therapeutic_category":"HEMOSTATICS (Medications to control bleeding)","therapeutic_class":"Hemostatics - Systemic","drug_name":"Aminocaproic Acid Solution 0.25 GM/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"GM/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"84100010000320","therapeutic_category":"HEMOSTATICS (Medications to control bleeding)","therapeutic_class":"Hemostatics - Systemic","drug_name":"Aminocaproic Acid Tablet 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"84100010000305","therapeutic_category":"HEMOSTATICS (Medications to control bleeding)","therapeutic_class":"Hemostatics - Systemic","drug_name":"Aminocaproic Acid Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35400005000303","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Amiodarone HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35400005000305","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Amiodarone HCl Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35400005000320","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Amiodarone HCl Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991502200150","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitor & Calcium Channel Blocker Combinations","drug_name":"amLODIPine Besy-Benazepril HCl Capsule 10-20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991502200160","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitor & Calcium Channel Blocker Combinations","drug_name":"amLODIPine Besy-Benazepril HCl Capsule 10-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991502200120","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitor & Calcium Channel Blocker Combinations","drug_name":"Amlodipine Besy-Benazepril HCl Capsule 2.5-10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991502200130","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitor & Calcium Channel Blocker Combinations","drug_name":"amLODIPine Besy-Benazepril HCl Capsule 5-10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991502200140","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitor & Calcium Channel Blocker Combinations","drug_name":"amLODIPine Besy-Benazepril HCl Capsule 5-20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991502200145","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitor & Calcium Channel Blocker Combinations","drug_name":"amLODIPine Besy-Benazepril HCl Capsule 5-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"34000003100340","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"amLODIPine Besylate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000003100320","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"amLODIPine Besylate Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000003100330","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"amLODIPine Besylate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36993002100330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine Besylate-Valsartan Tablet 10-160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36993002100340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine Besylate-Valsartan Tablet 10-320 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-320","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36993002100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine Besylate-Valsartan Tablet 5-160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36993002100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine Besylate-Valsartan Tablet 5-320 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-320","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36993002050330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine-Olmesartan Tablet 10-20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36993002050340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine-Olmesartan Tablet 10-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36993002050310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine-Olmesartan Tablet 5-20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36993002050320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Ca Channel Blocker Comb","drug_name":"amLODIPine-Olmesartan Tablet 5-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90050013000110","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Amnesteem CAPSULE 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Amnesteem CAPSULE 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000140","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Amnesteem CAPSULE 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4999300320B120","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Ulcer Anti-Infective w/ Proton Pump Inhibitors","drug_name":"Amoxicill-Clarithro-Lansopraz Therapy Pack 500 & 500 & 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500 & 500 & 30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010100105","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010100110","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010101910","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Suspension Reconstituted 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010101913","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Suspension Reconstituted 200 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010101915","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Suspension Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010101924","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Suspension Reconstituted 400 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010100303","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010100315","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Tablet 875 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"875","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010100505","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200010100510","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Amoxicillin Tablet Chewable 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002207420","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate ER Tablet Extended Release 12 Hour 1000-62.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000-62.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002201915","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Suspension Reconstituted 200-28.5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-28.5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002201920","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Suspension Reconstituted 250-62.5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-62.5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002201935","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Suspension Reconstituted 400-57 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-57","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002201960","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Suspension Reconstituted 600-42.9 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-42.9","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002200310","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Tablet 250-125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002200320","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Tablet 500-125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002200340","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Tablet 875-125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"875-125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002200515","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Tablet Chewable 200-28.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-28.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002200535","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Amoxicillin-Pot Clavulanate Tablet Chewable 400-57 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-57","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902107010","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902107015","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902107020","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902107025","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902107030","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902107005","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphet ER Capsule Extended Release 24 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902100310","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphetamine Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902100312","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphetamine Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902100315","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphetamine Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902100320","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphetamine Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902100330","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphetamine Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902100305","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphetamine Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61109902100307","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamine Mixtures","drug_name":"Amphetamine-Dextroamphetamine Tablet 7.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000010002105","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Amphotericin B Solution Reconstituted 50 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020200110","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302120","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 1 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302122","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 1 GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302132","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 10 GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302105","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 125 MG Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302125","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 2 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302127","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 2 GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302110","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 250 MG Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01200020302115","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminopenicillins","drug_name":"Ampicillin Sodium Solution Reconstituted 500 MG Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002252110","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Ampicillin-Sulbactam Sodium Solution Reconstituted 1.5 (1-0.5) GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5 (1-0.5)","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002252150","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15 (10-5)","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002252152","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Ampicillin-Sulbactam Sodium Solution Reconstituted 15 (10-5) GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15 (10-5)","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002252120","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Ampicillin-Sulbactam Sodium Solution Reconstituted 3 (2-1) GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3 (2-1)","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85156010100120","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Quinazoline Agents","drug_name":"Anagrelide HCl Capsule 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85156010100130","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Quinazoline Agents","drug_name":"Anagrelide HCl Capsule 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402810000310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Aromatase Inhibitors","drug_name":"Anastrozole Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78412000000500","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Pediatric Multiple Vitamins w/ C & FA","drug_name":"Animal Shapes Tablet Chewable with C & FA Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"with C & FA","strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25970002609020","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Vaginal","drug_name":"Annovera Ring 0.013-0.15 MG/24HR Vaginal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.013-0.15","strength_unit_of_measure":"MG/24HR","route":"Vaginal","dose_form":"Ring","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902958020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Anoro Ellipta Aerosol Powder Breath Activated 62.5-25 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"62.5-25","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Antacid Anti-Gas Max Strength Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101810","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Antacid Anti-Gas Suspension 200-200-20 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-200-20","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Antacid Calcium Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Antacid Extra Strength Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002300550","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"Antacid Extra Strength Tablet Chewable 675-135 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"675-135","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101810","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Antacid Fast Relief Suspension 200-200-20 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-200-20","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Antacid III Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Antacid Maximum Strength Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Antacid Maximum Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002300541","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"Antacid Tablet Chewable 550-110 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"550-110","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Antacid Ultra Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Antacid/Simethicone DS Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100105","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Anti-Diarrheal Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100905","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Anti-Diarrheal Liquid 1 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Anti-Itch Intensive Healing Lotion 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Anti-Itch Maximum Strength Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"7320301010E220","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Apomorphine HCl Solution Cartridge 30 MG/3ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100080200320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"APO-Varenicline Tablet 0.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"336","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100080200330","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"APO-Varenicline Tablet 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"336","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86602010102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Selective Alpha Adrenergic Agonists","drug_name":"Apraclonidine HCl Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50280020000130","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Substance P/Neurokinin 1 (NK1) Receptor Antagonists","drug_name":"Aprepitant Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"3","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50280020000110","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Substance P/Neurokinin 1 (NK1) Receptor Antagonists","drug_name":"Aprepitant Capsule 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"3","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50280020006320","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Substance P/Neurokinin 1 (NK1) Receptor Antagonists","drug_name":"Aprepitant Capsule 80 & 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"3","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80 & 125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50280020000120","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Substance P/Neurokinin 1 (NK1) Receptor Antagonists","drug_name":"Aprepitant Capsule 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"3","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1210301000G120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Integrase Inhibitors","drug_name":"Apretude Suspension Extended Release 600 MG/3ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG/3ML","route":"Intramuscular","dose_form":"Suspension Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Apri Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104585000120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Aptivus Capsule 250 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104585002020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Aptivus Solution 100 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78421000002020","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals & C","drug_name":"AquADEKs Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78310000000500","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Multiple Vitamins w/ Minerals","drug_name":"AquADEKs Tablet Chewable Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550075004115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Aquanil HC Lotion 1 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77202032000915","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin D","drug_name":"Aqueous Vitamin D Liquid 10 MCG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25992002200330","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Aranelle Tablet 0.5/1/0.5-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5/1/0.5-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401015102040","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) SOLUTION 100 MCG/ML INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401015102060","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) SOLUTION 200 MCG/ML INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401015102010","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) SOLUTION 25 MCG/ML INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401015102070","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution 300 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401015102020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) SOLUTION 40 MCG/ML INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401015102030","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) SOLUTION 60 MCG/ML INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E510","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 10 MCG/0.4ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/0.4ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E560","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 100 MCG/0.5ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E575","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 150 MCG/0.3ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MCG/0.3ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E582","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 200 MCG/0.4ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG/0.4ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E528","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 25 MCG/0.42ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG/0.42ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E588","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 300 MCG/0.6ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MCG/0.6ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E543","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 40 MCG/0.4ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MCG/0.4ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E590","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 500 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240101510E552","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Aranesp (Albumin Free) Solution Prefilled Syringe 60 MCG/0.3ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MCG/0.3ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66450060002120","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Interleukin-1 Blockers","drug_name":"Arcalyst Solution Reconstituted 220 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ARCALYST"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100072101920","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Arexvy Suspension Reconstituted 120 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44201012102520","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Arformoterol Tartrate Nebulization Solution 15 MCG/2ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MCG/2ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"07000010121830","therapeutic_category":"AMINOGLYCOSIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminoglycosides","drug_name":"Arikayce Suspension 590 MG/8.4ML Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"236","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"590","strength_unit_of_measure":"MG/8.4ML","route":"Inhalation","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"28100050000325","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid Tablet 120 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000305","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid Tablet 15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000330","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid Tablet 180 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000335","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid TABLET 240 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid Tablet 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000340","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid Tablet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000315","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid Tablet 60 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000320","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Armour Thyroid Tablet 90 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Arthritis Pain Reliever Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77108010000325","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin C","drug_name":"Ascorbic Acid Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300330","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Ashlyna Tablet 0.15-0.03 &0.01 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-0.03 &0.01","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (120 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (120 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/INH","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (14 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (14 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/INH","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208010","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 110 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"110","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208010","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 110 MCG/INH Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"110","strength_unit_of_measure":"MCG/INH","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (30 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/INH","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (60 Metered Doses) Aerosol Powder Breath Activated 220 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (60 Metered Doses) Aerosol Powder Breath Activated 220 MCG/INH Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/INH","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208010","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (7 Metered Doses) Aerosol Powder Breath Activated 110 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"110","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036208010","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex (7 Metered Doses) Aerosol Powder Breath Activated 110 MCG/INH Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"110","strength_unit_of_measure":"MCG/INH","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036203220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex HFA Aerosol 100 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"13","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036203230","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex HFA Aerosol 200 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"13","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400036203210","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Asmanex HFA Aerosol 50 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"13","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin 81 Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Adult Low Strength Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Adult Low Strength Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Childrens Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin EC Adult Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin EC Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin EC Low Strength Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Low Dose Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Low Strength Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010005228","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Suppository 600 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirin Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85159902206920","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Platelet Aggregation Inhibitor Combinations","drug_name":"Aspirin-Dipyridamole ER Capsule Extended Release 12 Hour 25-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000330","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Aspirtab Maximum Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97101530006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Peak Flow Meters","drug_name":"Assess Full Range Peak Meter Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97101530006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Peak Flow Meters","drug_name":"Assess Low Range Peak Meter Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97101530006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Peak Flow Meters","drug_name":"Assess Peak Flow Meter Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97101530006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Peak Flow Meters","drug_name":"AsthmaMentOr Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512065000630","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Atabex EC Tablet Delayed Release 29-1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"29-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512052000520","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Atabex Tablet Chewable 18-0.8 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12104515200130","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Atazanavir Sulfate Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104515200140","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Atazanavir Sulfate Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104515200150","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Atazanavir Sulfate Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33200020000310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Atenolol Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200020000303","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Atenolol Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200020000305","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Atenolol Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Atenolol-Chlorthalidone Tablet 100-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Atenolol-Chlorthalidone Tablet 50-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400010100310","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Atorvastatin Calcium Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400010100320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Atorvastatin Calcium Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400010100330","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Atorvastatin Calcium Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400010100350","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Atorvastatin Calcium Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"16400020001820","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Antiprotozoal Agents","drug_name":"Atovaquone Suspension 750 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13990002050320","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarial Combinations","drug_name":"Atovaquone-Proguanil HCl Tablet 250-100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13990002050310","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarial Combinations","drug_name":"Atovaquone-Proguanil HCl TABLET 62.5-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"62.5-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86350010102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Cycloplegic Mydriatics","drug_name":"Atropine Sulfate Solution 1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86350010102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Cycloplegic Mydriatics","drug_name":"Atropine-Care SOLUTION 1 % OPHTHALMIC","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44100030123420","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Bronchodilators - Anticholinergics","drug_name":"Atrovent HFA Aerosol Solution 17 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"17","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"4055001030B720","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Transthyretin Stabilizers","drug_name":"Attruby Tablet Therapy Pack 356 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"356","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533865000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Tropomyosin Receptor Kinase Inhibitors","drug_name":"Augtyro Capsule 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Aurora Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Aurora Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Aurora Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"6238003000B720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo Patient Titration Kit Tablet Therapy Pack 6 & 9 & 12 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"42","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6 & 9 & 12","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030000330","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo TABLET 12 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030000310","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo TABLET 6 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030000320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo TABLET 9 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6238003000C140","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Patient Titration Tablet Extended Release Therapy Pack 12 & 18 & 24 & 30 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12 & 18 & 24","strength_unit_of_measure":"& 30 MG","route":"Oral","dose_form":"Tablet Extended Release Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 12 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007525","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 18 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 24 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"24","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007535","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 30 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 36 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"36","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007545","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 42 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"42","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007550","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 48 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"48","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380030007510","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Austedo XR Tablet Extended Release 24 Hour 6 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Averi Tablet 0.15-0.03 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-0.03","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Aviane TABLET 0.1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020000310","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Avidoxy Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2199000207B120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic Combinations","drug_name":"Avmapki Fakzynja Co-Pack Therapy Pack 0.8 & 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.8 & 200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62403060456420","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Avonex Kit 30 MCG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"AVONEX"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MCG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240306045F530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Avonex Pen Auto-Injector Kit 30 MCG/0.5ML Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"AVONEX"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Auto-Injector Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240306045F830","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Avonex Prefilled Prefilled Syringe Kit 30 MCG/0.5ML Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"AVONEX"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21490009000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - PDGFR-alpha Inhibitors","drug_name":"Ayvakit Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21490009000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - PDGFR-alpha Inhibitors","drug_name":"Ayvakit Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21490009000310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - PDGFR-alpha Inhibitors","drug_name":"Ayvakit Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21490009000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - PDGFR-alpha Inhibitors","drug_name":"Ayvakit Tablet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21490009000315","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - PDGFR-alpha Inhibitors","drug_name":"Ayvakit Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"99406010000305","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Purine Analogs","drug_name":"azaTHIOprine Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"42401015102020","therapeutic_category":"NASAL AGENTS - SYSTEMIC AND TOPICAL (Medications to treat nasal congestion and nasal allergies)","therapeutic_class":"Nasal Antihistamines","drug_name":"Azelastine HCl Solution 0.1 % Nasal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"25"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"Nasal","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03400010003020","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Azithromycin","drug_name":"Azithromycin Packet 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03400010002120","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Azithromycin","drug_name":"Azithromycin Solution Reconstituted 500 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03400010001920","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Azithromycin","drug_name":"Azithromycin Suspension Reconstituted 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03400010001930","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Azithromycin","drug_name":"Azithromycin Suspension Reconstituted 200 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03400010000320","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Azithromycin","drug_name":"Azithromycin Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03400010000334","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Azithromycin","drug_name":"Azithromycin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03400010000340","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Azithromycin","drug_name":"Azithromycin Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16140010002120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Monobactams","drug_name":"Aztreonam Solution Reconstituted 1 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16140010002130","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Monobactams","drug_name":"Aztreonam Solution Reconstituted 2 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78110000000100","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"B-Complex Vitamins","drug_name":"B Complex Capsule Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78120000000100","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"B-Complex w/ C","drug_name":"B Complex-C Capsule Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77102010000340","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-2","drug_name":"B-2 Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77102010000160","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-2","drug_name":"B-2-400 Capsule 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Babys Only Organic/Dairy Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Babys Only Organic/DHA & ARA Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Babys Only Organic/Lactos Free Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Babys Only Organic/Soy Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Babys Only Orgnic/Sens DHA-ARA Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90100010004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"Bacitracin Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101005004205","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Bacitracin Ointment 500 UNIT/GM Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"Ophthalmic","dose_form":"Ointment","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"Bacitracin Zinc Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86109902104200","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Anti-infective Combinations","drug_name":"Bacitracin-Polymyxin B Ointment 500-10000 UNIT/GM Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10000","strength_unit_of_measure":"UNIT/GM","route":"Ophthalmic","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86309904104220","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroid Combinations","drug_name":"Bacitra-Neomycin-Polymyxin-HC Ointment 1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"Bacitraycin Plus Ointment 500 UNIT/GM External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100010000305","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Baclofen Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100010000310","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Baclofen Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100010000303","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Baclofen Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62405550006520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Nrf2 Pathway Activators","drug_name":"Bafiertam Capsule Delayed Release 95 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"95","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512097006332","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Bal-Care DHA 27-1 & 430 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"27-1 & 430","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"52500020100120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Inflammatory Bowel Agents","drug_name":"Balsalazide Disodium Capsule 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"270","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532225000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Balversa Tablet 3 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532225000325","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Balversa Tablet 4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532225000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Balversa Tablet 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"25990002500305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Balziva TABLET 0.4-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.4-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100105","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Banophen Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100920","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Banophen Liquid 12.5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Banophen Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300010002920","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Baqsimi One Pack Powder 3 MG/DOSE Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG/DOSE","route":"Nasal","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300010002920","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Baqsimi Two Pack Powder 3 MG/DOSE Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG/DOSE","route":"Nasal","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12352030002020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis B Agents","drug_name":"Baraclude SOLUTION 0.05 MG/ML ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"64100010000330","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Bayer Advanced Aspirin Ex St Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Bayer Advanced Aspirin Reg St Tablet 325 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Bayer Aspirin Regimen Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Bayer Aspirin Tablet 325 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Bayer Low Dose Tablet Chewable 81 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Bayer Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"BCAD 1 Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"BCAD 2 Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020256320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Disp Needle 25G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020186330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Disp Needles 18G X 1-1/2\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18G X 1-1/2\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020226330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Disp Needles 22G X 1-1/2\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1-1/2\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051020256310","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Disp Needles 25G X 5/8\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25G X 5/8\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020276305","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Disp Needles 27G X 1/2\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"27G X 1/2\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Eclipse Needle 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Eclipse Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036350","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Eclipse Syringe/Needle 22G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"83100020302021","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"BD Heparin PosiFlush Solution 10 UNIT/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"UNIT/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020302031","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"BD Heparin PosiFlush Solution 100 UNIT/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Hypodermic Needle 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051030906305","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Insulin Syringe 29G X 1/2\" 0.3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"29G X 1/2\"","strength_unit_of_measure":"0.3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051030056320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Insulin Syringe U-100 1 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"U-100","strength_unit_of_measure":"1 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051030906305","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Insulin Syringe Ultrafine 29G X 1/2\" 0.3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"29G X 1/2\"","strength_unit_of_measure":"0.3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Integra Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036360","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Integra Syringe 22G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036310","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lock Syringe 18G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036310","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 18G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036340","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 21G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051040036350","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 22G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036360","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 22G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036365","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 23G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"23G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036367","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 23G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"23G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036375","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 25G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036385","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Luer-Lok Syringe 25G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Mini U/F 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Mini Ultrafine 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Nano U/F 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Nano Ultrafine 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146331","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Orig Ultrafine 29G X 12.7MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"29G X 12.7MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146331","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Original U/F 29G X 12.7MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"29G X 12.7MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Short U/F 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Pen Needle Short Ultrafine 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Plastipak Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051010006303","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Plastipak Syringe 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3 ML","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79750010102024","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"BD PosiFlush Solution 0.9 % Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051020236330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD PrecisionGlide Needle 23G X 1-1/2\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"23G X 1-1/2\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051030906328","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD SafetyGlide Insulin Syringe 30G X 5/16\" 0.5 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30G X 5/16\"","strength_unit_of_measure":"0.5 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051030906333","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD SafetyGlide Insulin Syringe 31G X 15/64\" 0.3 ML","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 15/64\"","strength_unit_of_measure":"0.3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD SafetyGlide Needle 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051010006301","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Syringe Luer-Lok 1 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1 ML","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051010006303","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Syringe Luer-Lok 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3 ML","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051010006303","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Syringe Slip Tip 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3 ML","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036360","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"BD Syringe/Needle 22G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Beef/Potatoes/Spinach Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Benadryl Allergy Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Benadryl Allergy Ultratabs Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100005100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Benazepril HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100005100330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Benazepril HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100005100340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Benazepril HCl Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100005100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Benazepril HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802150320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Benazepril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802150330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Benazepril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802150340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Benazepril-hydroCHLOROthiazide Tablet 20-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802150310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Benazepril-hydroCHLOROthiazide Tablet 5-6.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-6.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46990004900300","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxative Combinations","drug_name":"Benefiber Plus B Vits & FA Tablet Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9942201500D520","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"B-Lymphocyte Stimulator (BLyS)-Specific Inhibitors","drug_name":"Benlysta Solution Auto-Injector 200 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9942201500E520","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"B-Lymphocyte Stimulator (BLyS)-Specific Inhibitors","drug_name":"Benlysta Solution Prefilled Syringe 200 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000003000340","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Benznidazole TABLET 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 12 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000003000320","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Benznidazole TABLET 12.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 12 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050010004005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Benzoyl Peroxide Gel 2.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050010004010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Benzoyl Peroxide Gel 5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050010000905","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Benzoyl Peroxide Wash Liquid 5 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90059902104010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Combinations","drug_name":"Benzoyl Peroxide-Erythromycin Gel 5-3 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-3","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73100010100305","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Anticholinergics","drug_name":"Benztropine Mesylate Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73100010100310","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Anticholinergics","drug_name":"Benztropine Mesylate Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73100010100315","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Anticholinergics","drug_name":"Benztropine Mesylate Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85802022006420","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"C1 Esterase Inhibitors","drug_name":"Berinert KIT 500 UNIT Intravenous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"C1 inhibitor"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT","route":"Intravenous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2170007750E520","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastics Misc.","drug_name":"Besremi Solution Prefilled Syringe 500 MCG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MCG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Beta HC Lotion 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30904520002920","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Homocystinuria Treatment - Agents","drug_name":"Betaine Powder Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020053705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Dipropionate Aug Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020054005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Dipropionate Aug Gel 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020054105","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Dipropionate Aug Lotion 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020054205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Dipropionate Aug Ointment 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020003705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Dipropionate Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020004105","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Dipropionate Lotion 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020004205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Dipropionate Ointment 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020103710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Valerate Cream 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020104105","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Valerate Lotion 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550020104205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Betamethasone Valerate Ointment 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62403060506420","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Betaseron KIT 0.3 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"BETASERON"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"15","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86250010102005","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Beta-blockers - Ophthalmic","drug_name":"Betaxolol HCl Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33200021100310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Betaxolol HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200021100320","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Betaxolol HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"54300010100320","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodics - Cholinergic Agonists","drug_name":"Bethanechol Chloride Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54300010100330","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodics - Cholinergic Agonists","drug_name":"Bethanechol Chloride Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54300010100310","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodics - Cholinergic Agonists","drug_name":"Bethanechol Chloride Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54300010100340","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodics - Cholinergic Agonists","drug_name":"Bethanechol Chloride Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902543220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Bevespi Aerosphere Aerosol 9-4.8 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10.70","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9-4.8","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21708220000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Selective Retinoid X Receptor Agonists","drug_name":"Bexarotene Capsule 75 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"90376220004020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Topical Selective Retinoid X Receptor Agonists","drug_name":"Bexarotene Gel 1 % External","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1720004015E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Bexsero Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1950205205E530","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Antiviral Monoclonal Antibodies","drug_name":"Beyfortus Solution Prefilled Syringe 100 MG/ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1950205205E520","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Antiviral Monoclonal Antibodies","drug_name":"Beyfortus Solution Prefilled Syringe 50 MG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/0.5ML","route":"Intramuscular","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402420000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiandrogens","drug_name":"Bicalutamide Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002101825","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Bicillin C-R Suspension 1200000 UNIT/2ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1200000","strength_unit_of_measure":"UNIT/2ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"0110002000E630","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Bicillin L-A Suspension Prefilled Syringe 1200000 UNIT/2ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1200000","strength_unit_of_measure":"UNIT/2ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"0110002000E620","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Bicillin L-A Suspension Prefilled Syringe 2400000 UNIT/4ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2400000","strength_unit_of_measure":"UNIT/4ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"0110002000E610","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Bicillin L-A Suspension Prefilled Syringe 600000 UNIT/ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600000","strength_unit_of_measure":"UNIT/ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903240320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Biktarvy Tablet 30-120-15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30-120-15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903240330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Biktarvy Tablet 50-200-25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-200-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94101024356400","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Infection Tests","drug_name":"BinaxNOW COVID-19 Ag Home Test Kit In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000060002900","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Bio-Statin Powder Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200005101800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"BioThrax SUSPENSION Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Bisacodyl EC Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Bismuth Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33200022100320","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Bisoprolol Fumarate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200022100310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Bisoprolol Fumarate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002130330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Bisoprolol-hydroCHLOROthiazide Tablet 10-6.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-6.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002130310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Bisoprolol-hydroCHLOROthiazide Tablet 2.5-6.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-6.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002130320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Bisoprolol-hydroCHLOROthiazide Tablet 5-6.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-6.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97750010006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Blood Pressure Devices","drug_name":"Blood Pressure Monitor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97750010006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Blood Pressure Devices","drug_name":"Blood Pressure Monitor Device","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97750010006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Blood Pressure Devices","drug_name":"Blood Pressure Monitor/Arm Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50309902100430","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetic Combinations","drug_name":"Bonjesta Tablet Extended Release 20-20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Boost Glucose Control Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Boost High Protein Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Boost Kid Essentials 1.5 Cal Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Boost Kid Essentials 1.5/Fiber Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Boost Plus Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990003221820","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Boostrix SUSPENSION 5-2.5-18.5 Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5-2.5-18.5","strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40160015000330","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulmonary Hypertension - Endothelin Receptor Antagonists","drug_name":"Bosentan Tablet 125 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40160015000320","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulmonary Hypertension - Endothelin Receptor Antagonists","drug_name":"Bosentan Tablet 62.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"62.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531812000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Bosulif Capsule 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531812000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Bosulif Capsule 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531812000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Bosulif Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531812000327","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Bosulif Tablet 400 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531812000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Bosulif Tablet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"78510030000320","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal Vitamins","drug_name":"BP FoliNatal Plus B Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512050000330","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"BP MultiNatal Plus Tablet 30-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512050000540","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"BP MultiNatal Plus Tablet Chewable 40-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90050010000903","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"BP Wash Liquid 2.5 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000002010","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"BProtected Pedia Poly-Vite/Fe Solution 10 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78430000002012","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"BProtected Pedia Poly-Vite/Fe Solution 11 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"11","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21532040000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BRAF Kinase Inhibitors","drug_name":"Braftovi Capsule 75 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902758020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Breo Ellipta Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-25","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902758030","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Breo Ellipta Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-25","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902758010","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Breo Ellipta Aerosol Powder Breath Activated 50-25 MCG/INH Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-25","strength_unit_of_measure":"MCG/INH","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"11507040100320","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungal - Glucan Synthesis Inhibitors (Triterpenoids)","drug_name":"Brexafemme Tablet 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902413240","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Breyna Aerosol 160-4.5 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160-4.5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902413220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Breyna Aerosol 80-4.5 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80-4.5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209903303220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Breztri Aerosphere Aerosol 160-9-4.8 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10.70","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160-9-4.8","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002500305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Briellyn Tablet 0.4-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Bright Beginnings Pediatric Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86602020102007","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Selective Alpha Adrenergic Agonists","drug_name":"Brimonidine Tartrate Solution 0.15 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86602020102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Selective Alpha Adrenergic Agonists","drug_name":"Brimonidine Tartrate Solution 0.2 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"6520001000E565","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Brixadi (Weekly) Solution Prefilled Syringe 16 MG/0.32ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"16","strength_unit_of_measure":"MG/0.32ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6520001000E570","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Brixadi (Weekly) Solution Prefilled Syringe 24 MG/0.48ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.92","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"24","strength_unit_of_measure":"MG/0.48ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6520001000E575","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Brixadi (Weekly) Solution Prefilled Syringe 32 MG/0.64ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32","strength_unit_of_measure":"MG/0.64ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6520001000E560","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Brixadi (Weekly) Solution Prefilled Syringe 8 MG/0.16ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.64","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG/0.16ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6520001000E523","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Brixadi Solution Prefilled Syringe 128 MG/0.36ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.36","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"128","strength_unit_of_measure":"MG/0.36ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6520001000E515","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Brixadi Solution Prefilled Syringe 64 MG/0.18ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.18","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"64","strength_unit_of_measure":"MG/0.18ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6520001000E518","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Brixadi Solution Prefilled Syringe 96 MG/0.27ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.27","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"96","strength_unit_of_measure":"MG/0.27ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86805005102060","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Nonsteroidal Anti-inflammatory Agents","drug_name":"Bromfenac Sodium (Once-Daily) Solution 0.09 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6.80","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.09","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86805005102007","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Nonsteroidal Anti-inflammatory Agents","drug_name":"Bromfenac Sodium Solution 0.07 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.07","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200020100105","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Bromocriptine Mesylate Capsule 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200020100305","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Bromocriptine Mesylate Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45307060000140","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agents - Miscellaneous","drug_name":"Bronchitol Capsule 40 MG Inhalation","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"560","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Inhalation","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45307060000140","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agents - Miscellaneous","drug_name":"Bronchitol Tolerance Test Capsule 40 MG Inhalation","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"560","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Inhalation","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532195000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Brukinsa Capsule 80 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532195000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Brukinsa Tablet 160 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100012006720","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Budesonide Capsule Delayed Release Particles 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release Particles","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"89150007003920","therapeutic_category":"ANORECTAL AND RELATED PRODUCTS(Medications to treat pain and inflammation in the anus or rectum)","therapeutic_class":"Intrarectal Steroids","drug_name":"Budesonide Foam 2 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Foam","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44400015001830","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Budesonide Suspension 0.25 MG/2ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG/2ML","route":"Inhalation","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400015001840","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Budesonide Suspension 0.5 MG/2ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG/2ML","route":"Inhalation","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400015001850","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Budesonide Suspension 1 MG/2ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/2ML","route":"Inhalation","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902413240","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Budesonide-Formoterol Fumarate Aerosol 160-4.5 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160-4.5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902413220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Budesonide-Formoterol Fumarate Aerosol 80-4.5 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80-4.5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37200010000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Bumetanide Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37200010000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Bumetanide Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37200010000315","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Bumetanide Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"65200010100760","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl Tablet Sublingual 2 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"480","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Tablet Sublingual","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200010100780","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl Tablet Sublingual 8 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Tablet Sublingual","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200010208250","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl-Naloxone HCl Film 12-3 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12-3","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Film","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200010208220","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl-Naloxone HCl Film 2-0.5 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"480","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2-0.5","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Film","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200010208230","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl-Naloxone HCl Film 4-1 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4-1","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Film","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200010208240","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl-Naloxone HCl Film 8-2 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8-2","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Film","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200010200720","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl-Naloxone HCl Tablet Sublingual 2-0.5 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"480","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2-0.5","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Tablet Sublingual","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200010200740","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Buprenorphine HCl-Naloxone HCl Tablet Sublingual 8-2 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8-2","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Tablet Sublingual","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100002107430","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"buPROPion HCl ER (Smoking Det) Tablet Extended Release 12 Hour 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64991002120310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics-Sedatives","drug_name":"Butalbital-Acetaminophen Tablet 50-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64991003100108","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics-Sedatives","drug_name":"Butalbital-APAP-Caffeine Capsule 50-300-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-300-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64991003100110","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics-Sedatives","drug_name":"Butalbital-APAP-Caffeine Capsule 50-325-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-325-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64991003100310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics-Sedatives","drug_name":"Butalbital-APAP-Caffeine Tablet 50-325-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-325-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64991003300120","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics-Sedatives","drug_name":"Butalbital-ASA-Caffeine Capsule 50-325-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-325-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65200020102050","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Partial Agonists","drug_name":"Butorphanol Tartrate Solution 10 MG/ML Nasal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Nasal","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"2717002000D420","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Bydureon BCise Auto-Injector 2 MG/0.85ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/0.85ML","route":"Subcutaneous","dose_form":"Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717002000D240","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Byetta 10 MCG Pen Solution Pen-Injector 10 MCG/0.04ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GLUCAGON-LIKE PEPTIDE-1 AGONISTS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.40","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/0.04ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717002000D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Byetta 5 MCG Pen Solution Pen-Injector 5 MCG/0.02ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GLUCAGON-LIKE PEPTIDE-1 AGONISTS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MCG/0.02ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1210990225G120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Cabenuva Suspension Extended Release 400 & 600 MG/2ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400 & 600","strength_unit_of_measure":"MG/2ML","route":"Intramuscular","dose_form":"Suspension Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1210990225G130","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Cabenuva Suspension Extended Release 600 & 900 MG/3ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600 & 900","strength_unit_of_measure":"MG/3ML","route":"Intramuscular","dose_form":"Suspension Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30402020000320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Dopamine Receptor Agonists","drug_name":"Cabergoline Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85151020806420","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Anti-von Willebrand Factor Agents","drug_name":"Cablivi Kit 11 MG Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"11","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533010100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Cabometyx Tablet 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21533010100330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Cabometyx Tablet 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21533010100340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Cabometyx Tablet 60 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"61300010102060","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Analeptics","drug_name":"Caffeine Citrate Solution 20 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61300010102060","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Analeptics","drug_name":"Caffeine Citrate Solution 60 MG/3ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/3ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77202030002030","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin D","drug_name":"Calcidol Solution 200 MCG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Calcilo XD Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90250025003710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics","drug_name":"Calcipotriene Cream 0.005 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.005","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30043020002080","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Calcitonins","drug_name":"Calcitonin (Salmon) Solution 200 UNIT/ACT Nasal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"UNIT/ACT","route":"Nasal","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905030000105","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Calcitriol Capsule 0.25 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905030000110","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Calcitriol Capsule 0.5 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905030002050","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Calcitriol Solution 1 MCG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MCG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640380","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 1000 + D Tablet 1000-20 MG-MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640333","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 500 + D Tablet 500-3.125 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-3.125","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 500 + D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 500/D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 500+D High Potency Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 500+D Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 500+D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600 + D Tablet 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902630368","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600 +D High Potency Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium 600 High Potency Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium 600 Tablet 1500 (600 Ca) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1500 (600 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium 600 Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600/Vitamin D Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640550","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600/Vitamin D Tablet Chewable 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640357","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600/Vitamin D3 Tablet 600-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600+D High Potency Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600+D Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902630365","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600+D Tablet 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600+D3 Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium 600+D3 Tablet 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52800020100120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Phosphate Binder Agents","drug_name":"Calcium Acetate (Phos Binder) Capsule 667 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"667","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52800020100320","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Phosphate Binder Agents","drug_name":"Calcium Acetate (Phos Binder) Tablet 667 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"667","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100006000309","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Acetate Tablet 668 (169 Ca) MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"668 (169 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Calcium Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Calcium Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Calcium Antacid Ultra Max St Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Calcium Antacid Ultra Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Carb-Cholecalciferol Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Carb-Cholecalciferol Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640349","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Carb-Cholecalciferol Tablet 600-3.125 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-3.125","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640525","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Carb-Cholecalciferol Tablet Chewable 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010001815","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Calcium Carbonate Antacid Suspension 1250 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000309","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Calcium Carbonate Antacid Tablet 648 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"648","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Calcium Carbonate Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000345","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Carbonate Tablet 1250 (500 Ca) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1250 (500 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Carbonate Tablet 1500 (600 Ca) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1500 (600 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Carbonate Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902630150","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Carbonate-Vitamin D Capsule 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100015000302","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Citrate Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100015000303","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Citrate Tablet 250 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100015000310","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Citrate Tablet 950 (200 Ca) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"950 (200 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902660315","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Citrate-Vitamin D Tablet 200-3.125 MG-MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-3.125","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902660330","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Citrate-Vitamin D Tablet 315-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"315-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640550","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Creamies Tablet Chewable 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100030000305","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Gluconate Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium High Potency Tablet 1500 (600 Ca) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1500 (600 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium High Potency TABLET 600 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium High Potency/Vitamin D Tablet 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100040000380","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Lactate Tablet 648 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"648","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640160","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium Plus Vitamin D3 Capsule 600-12.5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-12.5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100005000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100005000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Calcium Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902630360","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium-Vitamin D Tablet 600-3.125 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-3.125","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640160","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Calcium-Vitamin D3 Capsule 600-12.5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-12.5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Cal-Gest Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78510000000350","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal Vitamins","drug_name":"Calna Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21532103500320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Calquence Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"79100007000350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Caltrate 600 Tablet 1500 (600 Ca) MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1500 (600 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2140501055E420","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Camcevi Prefilled Syringe 42 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"42","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Camila Tablet 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300315","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Camrese Lo TABLET 0.1-0.02 & 0.01 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.1-0.02 & 0.01","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40190050000130","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Cardiac Myosin Inhibitors","drug_name":"Camzyos Capsule 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40190050000140","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Cardiac Myosin Inhibitors","drug_name":"Camzyos Capsule 15 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40190050000110","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Cardiac Myosin Inhibitors","drug_name":"Camzyos Capsule 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40190050000120","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Cardiac Myosin Inhibitors","drug_name":"Camzyos Capsule 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11500025102120","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungal - Glucan Synthesis Inhibitors (Echinocandins)","drug_name":"Cancidas Solution Reconstituted 50 MG Intravenous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11500025102130","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungal - Glucan Synthesis Inhibitors (Echinocandins)","drug_name":"Cancidas Solution Reconstituted 70 MG Intravenous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36150020100330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Candesartan Cilexetil Tablet 16 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"16","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150020100340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Candesartan Cilexetil Tablet 32 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150020100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Candesartan Cilexetil Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150020100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Candesartan Cilexetil Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002200320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Candesartan Cilexetil-HCTZ Tablet 16-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"16-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002200340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Candesartan Cilexetil-HCTZ Tablet 32-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002200350","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Candesartan Cilexetil-HCTZ Tablet 32-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64991003100110","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics-Sedatives","drug_name":"Capacet Capsule 50-325-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-325-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300005000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Capecitabine Tablet 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300005000350","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Capecitabine Tablet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533085000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Caprelsa Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CAPRELSA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533085000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Caprelsa Tablet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CAPRELSA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100010000320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Captopril Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100010000305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Captopril Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100010000310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Captopril Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100010000315","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Captopril Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"1720006550E520","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Capvaxive Solution Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600020006910","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine ER Capsule Extended Release 12 Hour 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020006920","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine ER Capsule Extended Release 12 Hour 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020006930","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine ER Capsule Extended Release 12 Hour 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020007410","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine ER Tablet Extended Release 12 Hour 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020007420","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine ER Tablet Extended Release 12 Hour 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020007440","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine ER Tablet Extended Release 12 Hour 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020001810","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020000305","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600020000505","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"carBAMazepine Tablet Chewable 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"73209902100410","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa ER Tablet Extended Release 25-100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209902100420","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa ER Tablet Extended Release 50-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209902100310","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa Tablet 10-100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209902100320","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa Tablet 25-100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209902100330","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa Tablet 25-250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209902107210","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa Tablet Dispersible 10-100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209902107220","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa Tablet Dispersible 25-100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209902107230","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa Tablet Dispersible 25-250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209903300320","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa-Entacapone Tablet 12.5-50-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5-50-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209903300325","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa-Entacapone Tablet 18.75-75-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18.75-75-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209903300330","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa-Entacapone Tablet 25-100-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-100-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209903300335","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa-Entacapone Tablet 31.25-125-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31.25-125-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209903300340","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa-Entacapone Tablet 37.5-150-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"37.5-150-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73209903300350","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Levodopa Combinations","drug_name":"Carbidopa-Levodopa-Entacapone Tablet 50-200-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-200-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"CareOne Unifine Pentips Plus 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"75100020000305","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Carisoprodol Tablet 350 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"350","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86250012102005","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Beta-blockers - Ophthalmic","drug_name":"Carteolol HCl SOLUTION 1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127020","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Cartia XT Capsule Extended Release 24 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127030","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Cartia XT Capsule Extended Release 24 Hour 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127040","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Cartia XT Capsule Extended Release 24 Hour 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127050","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Cartia XT Capsule Extended Release 24 Hour 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33300007000320","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Alpha-Beta Blockers","drug_name":"Carvedilol Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33300007000330","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Alpha-Beta Blockers","drug_name":"Carvedilol Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33300007000305","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Alpha-Beta Blockers","drug_name":"Carvedilol Tablet 3.125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33300007000310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Alpha-Beta Blockers","drug_name":"Carvedilol Tablet 6.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97402010005400","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Diaphragms","drug_name":"Caya DIAPHRAGM VAGINAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Vaginal","dose_form":"Diaphragm","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16140010402120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Monobactams","drug_name":"Cayston Solution Reconstituted 75 MG Inhalation","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Inhalation","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200040000105","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefaclor Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200040000110","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefaclor Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200040107430","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefaclor ER Tablet Extended Release 12 Hour 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200040001910","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefaclor Suspension Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100010000105","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cefadroxil Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100010001910","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cefadroxil Suspension Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100010001915","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cefadroxil Suspension Reconstituted 500 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100010000305","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cefadroxil Tablet 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300040000120","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefdinir Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300040001920","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefdinir Suspension Reconstituted 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300040001930","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefdinir Suspension Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300060000120","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefixime Capsule 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300065101930","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefpodoxime Proxetil Suspension Reconstituted 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300065101920","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefpodoxime Proxetil Suspension Reconstituted 50 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300065100320","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefpodoxime Proxetil Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300065100330","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Cefpodoxime Proxetil Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200062001910","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefprozil Suspension Reconstituted 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200062001920","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefprozil Suspension Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200062000320","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefprozil Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200062000330","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefprozil Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300090102115","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"cefTRIAXone Sodium Solution Reconstituted 1 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300090102105","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"cefTRIAXone Sodium Solution Reconstituted 250 MG Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02300090102110","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"cefTRIAXone Sodium Solution Reconstituted 500 MG Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200065050310","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefuroxime Axetil Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02200065050315","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 2nd Generation","drug_name":"Cefuroxime Axetil Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100525000120","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Cyclooxygenase 2 (COX-2) Inhibitors","drug_name":"Celecoxib Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100525000130","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Cyclooxygenase 2 (COX-2) Inhibitors","drug_name":"Celecoxib Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100525000140","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Cyclooxygenase 2 (COX-2) Inhibitors","drug_name":"Celecoxib Capsule 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100525000110","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Cyclooxygenase 2 (COX-2) Inhibitors","drug_name":"Celecoxib Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100020000105","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cephalexin Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100020000110","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cephalexin Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100020001910","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cephalexin Suspension Reconstituted 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"02100020001915","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 1st Generation","drug_name":"Cephalexin Suspension Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82700040600120","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Agents for Gaucher Disease","drug_name":"Cerdelga Capsule 84 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Cerdelga"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"84","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000000518","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"Cerovite Jr Tablet Chewable 18 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"41550020102010","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"Cetirizine HCl Allergy Child Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41550020100320","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"Cetirizine HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41550020100310","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"Cetirizine HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93000007000840","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes and Specific Antagonists","drug_name":"Cetylev Tablet Effervescent 2.5 GM Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Effervescent","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93000007000820","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes and Specific Antagonists","drug_name":"Cetylev Tablet Effervescent 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Effervescent","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93000010100110","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes and Specific Antagonists","drug_name":"CharcoCaps Capsule 260 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"260","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94109902406100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Multiple Urine Tests","drug_name":"Chemstrip uGK Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007210","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Childrens Acetaminophen Tablet Dispersible 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Childrens Aspirin Low Strength Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Childrens Aspirin Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78410000000500","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Pediatric Multiple Vitamins","drug_name":"Childrens Chewable Vitamins Tablet Chewable Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78420000000501","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals","drug_name":"Childrens Gummies Tablet Chewable Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Childrens Ibuprofen 100 Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Childrens Ibuprofen Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Childrens Ibuprofen Suspension 200 MG/10ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/10ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41550030002020","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"Childrens Loratadine Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Childrens Medi-Profen Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Childrens Medi-Tabs Tablet Chewable 80 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Childrens Non-ASA Pain Relief Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Childrens Non-Aspirin Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Childrens Non-Aspirin Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Childrens Pain Reliever Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007210","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Childrens Pain Reliever Tablet Dispersible 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000504","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Childrens Pepto Tablet Chewable 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000504","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Childrens Soothe Tablet Chewable 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000914","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Chloraseptic Sore Throat Liquid 1000 MG/30ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG/30ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"92100030100940","therapeutic_category":"ANTISEPTICS & DISINFECTANTS (Agents to clean and disinfect the skin)","therapeutic_class":"Chlorine Antiseptics","drug_name":"Chlorhexidine Gluconate Liquid 4 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"96200034302000","therapeutic_category":"CHEMICALS (Miscellaneous liquid therapeutic agents)","therapeutic_class":"Liquids","drug_name":"Chlorhexidine Gluconate Solution","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"88150020102012","therapeutic_category":"MOUTH/THROAT/DENTAL AGENTS (Medications to treat inflammation, pain or other conditions in the mouth)","therapeutic_class":"Antiseptics - Mouth/Throat","drug_name":"Chlorhexidine Gluconate Solution 0.12 % Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.12","strength_unit_of_measure":"%","route":"Mouth/Throat","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"92100030102060","therapeutic_category":"ANTISEPTICS & DISINFECTANTS (Agents to clean and disinfect the skin)","therapeutic_class":"Chlorine Antiseptics","drug_name":"Chlorhexidine Gluconate Solution 20 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"%","route":null,"dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"92100030102020","therapeutic_category":"ANTISEPTICS & DISINFECTANTS (Agents to clean and disinfect the skin)","therapeutic_class":"Chlorine Antiseptics","drug_name":"Chlorhexidine Gluconate Solution 4 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13000010200305","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarials","drug_name":"Chloroquine Phosphate Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13000010200310","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarials","drug_name":"Chloroquine Phosphate Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"37600020000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"Chlorothiazide Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600020000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"Chlorothiazide Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600025000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"Chlorthalidone Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600025000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"Chlorthalidone Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39100010103005","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Bile Acid Sequestrants","drug_name":"Cholestyramine Light Packet 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39100010102905","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Bile Acid Sequestrants","drug_name":"Cholestyramine Light Powder 4 GM/DOSE Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM/DOSE","route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39100010003005","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Bile Acid Sequestrants","drug_name":"Cholestyramine Packet 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39100010002905","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Bile Acid Sequestrants","drug_name":"Cholestyramine Powder 4 GM/DOSE Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM/DOSE","route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Cholextra Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64109902200910","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylate Combinations","drug_name":"Choline-Mag Trisalicylate Liquid 500 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79900030122020","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Trace Minerals","drug_name":"Chromic Chloride Solution 40 MCG/10ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MCG/10ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85155516000330","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Phosphodiesterase III Inhibitors","drug_name":"Cilostazol Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85155516000320","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Phosphodiesterase III Inhibitors","drug_name":"Cilostazol Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902470330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Cimduo Tablet 300-300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49200010102050","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Cimetidine HCl Solution 300 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200010000305","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Cimetidine Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200010000310","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Cimetidine Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200010000315","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Cimetidine Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200010000320","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Cimetidine Tablet 800 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"5250502010F840","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Tumor Necrosis Factor Alpha Blockers","drug_name":"Cimzia (2 Syringe) Prefilled Syringe Kit 200 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CIMZIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52505020106420","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Tumor Necrosis Factor Alpha Blockers","drug_name":"Cimzia KIT 2 X 200 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CIMZIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 X 200","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5250502010F840","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Tumor Necrosis Factor Alpha Blockers","drug_name":"Cimzia Prefilled Prefilled Syringe Kit 2 X 200 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CIMZIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 X 200","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5250502010F840","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Tumor Necrosis Factor Alpha Blockers","drug_name":"Cimzia Prefilled Syringe Kit 2 X 200 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CIMZIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 X 200","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5250502010F860","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Tumor Necrosis Factor Alpha Blockers","drug_name":"Cimzia Starter Kit Prefilled Syringe Kit 6 X 200 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CIMZIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6 X 200","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5250502010F840","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Tumor Necrosis Factor Alpha Blockers","drug_name":"Cimzia-Starter Prefilled Syringe Kit 200 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"CIMZIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905225100320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Calcimimetic Agents","drug_name":"Cinacalcet HCl Tablet 30 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905225100330","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Calcimimetic Agents","drug_name":"Cinacalcet HCl Tablet 60 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905225100340","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Calcimimetic Agents","drug_name":"Cinacalcet HCl Tablet 90 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85802022002120","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"C1 Esterase Inhibitors","drug_name":"Cinryze Solution Reconstituted 500 UNIT Intravenous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"C1 inhibitor"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020001920","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Cipro Suspension Reconstituted 250 MG/5ML (5%) Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250 MG/5ML","strength_unit_of_measure":"(5%)","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020001930","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Cipro Suspension Reconstituted 500 MG/5ML (10%) Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500 MG/5ML","strength_unit_of_measure":"(10%)","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87100012102020","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Anti-infectives","drug_name":"Ciprofloxacin HCl Solution 0.2 % Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"%","route":"Otic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101023102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Ciprofloxacin HCl Solution 0.3 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020100305","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020100310","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin HCl Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020100315","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin HCl Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020100320","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin HCl Tablet 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020112024","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin in D5W Solution 200 MG/100ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/100ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020112028","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin in D5W Solution 400 MG/200ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG/200ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020002024","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin Solution 200 MG/20ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/20ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020002026","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin Solution 400 MG/40ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG/40ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020001920","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin Suspension Reconstituted 250 MG/5ML (5%) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250 MG/5ML","strength_unit_of_measure":"(5%)","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020001930","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin Suspension Reconstituted 500 MG/5ML (10%) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500 MG/5ML","strength_unit_of_measure":"(10%)","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020057540","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin-Ciproflox HCl ER Tablet Extended Release 24 Hour 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000020057520","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ciprofloxacin-Ciproflox HCl ER Tablet Extended Release 24 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87991002361820","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Steroid-Anti-infective Combinations","drug_name":"Ciprofloxacin-Dexamethasone Suspension 0.3-0.1 % Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3-0.1","strength_unit_of_measure":"%","route":"Otic","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902660333","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Citracal Maximum Tablet 315-6.25 MG-MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"315-6.25","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78516035000125","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"CitraNatal Harmony CAPSULE 27-1-250 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"27-1-250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90050013000110","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Claravis CAPSULE 10 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Claravis Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000130","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Claravis Capsule 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000140","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Claravis Capsule 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03500010007520","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Clarithromycin","drug_name":"Clarithromycin ER Tablet Extended Release 24 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03500010001910","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Clarithromycin","drug_name":"Clarithromycin SUSPENSION RECONSTITUTED 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03500010001920","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Clarithromycin","drug_name":"Clarithromycin Suspension Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03500010000310","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Clarithromycin","drug_name":"Clarithromycin Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03500010000320","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Clarithromycin","drug_name":"Clarithromycin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512015000328","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Classic Prenatal Tablet 28-0.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46600033002910","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"ClearLax Powder 17 GM/SCOOP Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM/SCOOP","route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Click Espresso Protein Drink Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Clickfine Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Clickfine Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Clickfine Pen Needles 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"16220020100110","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Lincosamides","drug_name":"Clindamycin HCl Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16220020100120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Lincosamides","drug_name":"Clindamycin HCl Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16220020100105","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Lincosamides","drug_name":"Clindamycin HCl Capsule 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16220020222120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Lincosamides","drug_name":"Clindamycin Palmitate HCl Solution Reconstituted 75 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051010104006","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Clindamycin Phos (Once-Daily) Gel 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":"PA applies above age range","protected_class":false,"emergency_fill":false},{"gpi":"90051010104007","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Clindamycin Phos (Twice-Daily) Gel 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":"PA applies above age range","protected_class":false,"emergency_fill":false},{"gpi":"55100018103720","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Anti-infectives","drug_name":"Clindamycin Phosphate Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051010104005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Clindamycin Phosphate Gel 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":"PA applies above age range","protected_class":false,"emergency_fill":false},{"gpi":"90051010104105","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Clindamycin Phosphate Lotion 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051010102005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Clindamycin Phosphate Solution 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051010109420","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Clindamycin Phosphate Swab 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Swab","multisource_indicator":"Y","prescriber_note":"PA applies above age range","protected_class":false,"emergency_fill":false},{"gpi":"72100007001830","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"cloBAZam Suspension 2.5 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100007000310","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"cloBAZam Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100007000320","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"cloBAZam Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550025103705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Clobetasol Propionate Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550025104010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Clobetasol Propionate Gel 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550025104205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Clobetasol Propionate Ointment 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550025104520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Clobetasol Propionate Shampoo 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Shampoo","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550025102005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Clobetasol Propionate Solution 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72100010000305","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100010000310","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100010000315","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"300","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100010007210","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet Dispersible 0.125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100010007215","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet Dispersible 0.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100010007220","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet Dispersible 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100010007230","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet Dispersible 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100010007240","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"clonazePAM Tablet Dispersible 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"300","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201010100305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"cloNIDine HCl Tablet 0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201010100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"cloNIDine HCl Tablet 0.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201010100315","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"cloNIDine HCl Tablet 0.3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201010008810","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"cloNIDine Patch Weekly 0.1 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201010008820","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"cloNIDine Patch Weekly 0.2 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201010008830","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"cloNIDine Patch Weekly 0.3 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"85158020100340","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Thienopyridine Derivatives","drug_name":"Clopidogrel Bisulfate Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85158020100320","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Thienopyridine Derivatives","drug_name":"Clopidogrel Bisulfate Tablet 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104020003710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Clotrimazole 3 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90154020003705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Imidazole-Related Antifungals - Topical","drug_name":"Clotrimazole Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104020003705","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Clotrimazole Cream 1 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90154020002005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Imidazole-Related Antifungals - Topical","drug_name":"Clotrimazole Solution 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104020003705","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Clotrimazole-7 Cream 1 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90159902053710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical Combinations","drug_name":"Clotrimazole-Betamethasone Cream 1-0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90159902054120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical Combinations","drug_name":"Clotrimazole-Betamethasone Lotion 1-0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512018000116","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"C-Nate DHA CAPSULE 28-1-200 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-1-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"13990002030320","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarial Combinations","drug_name":"Coartem Tablet 20-120 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20-120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78101030001700","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamins A & D","drug_name":"Cod Liver Oil Oil Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Oil","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"65100020200305","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Codeine Sulfate Tablet 15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100020200310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Codeine Sulfate Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100020200315","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Codeine Sulfate Tablet 60 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"68000020000310","therapeutic_category":"GOUT AGENTS (Medications to treat gout)","therapeutic_class":"Gout Agents","drug_name":"Colchicine Tablet 0.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"68990002100310","therapeutic_category":"GOUT AGENTS (Medications to treat gout)","therapeutic_class":"Gout Agent Combinations","drug_name":"Colchicine-Probenecid Tablet 0.5-500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"FEBUXOSTAT","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39100020102705","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Bile Acid Sequestrants","drug_name":"Colestipol HCl Granules 5 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Granules","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39100020103010","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Bile Acid Sequestrants","drug_name":"Colestipol HCl Packet 5 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39100020100320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Bile Acid Sequestrants","drug_name":"Colestipol HCl Tablet 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902013420","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Combivent Respimat Aerosol Solution 20-100 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20-100","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21534013106470","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Tyrosine Kinase Inhibitors","drug_name":"Cometriq (100 mg Daily Dose) KIT 1 X 80 & 1 X 20 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1 X 80 & 1 X 20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21534013106480","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Tyrosine Kinase Inhibitors","drug_name":"Cometriq (140 mg Daily Dose) KIT 1 X 80 & 3 X 20 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1 X 80 & 3 X 20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533010106460","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Cometriq (60 MG Daily Dose) Kit 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Comfort EZ Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Comfort EZ Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Comfort EZ Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Comfort EZ Pen Needles 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Comfort Gel Antacid Anti-Gas Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100002401824","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Comirnaty Suspension 30 MCG/0.3ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MCG/0.3ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710000240E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Comirnaty Suspension Prefilled Syringe 30 MCG/0.3ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MCG/0.3ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Compleat Pediatric Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"41200030100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Ethanolamines","drug_name":"Complete Allergy Medicine Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78515022006315","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-CA-Omega 3 Fish Oil","drug_name":"Complete Natal DHA 29-1-200 & 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1-200 & 200","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78515022006320","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-CA-Omega 3 Fish Oil","drug_name":"Complete Natal DHA 29-1-200 & 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1-200 & 250","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000530","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"CompleteNate Tablet Chewable 29-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000332","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Co-Natal FA Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97401000000000","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Condoms - Male","drug_name":"Condoms","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21538030000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Phosphatidylinositol 3-Kinase (PI3K) Inhibitors","drug_name":"Copiktra Capsule 15 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21538030000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Phosphatidylinositol 3-Kinase (PI3K) Inhibitors","drug_name":"Copiktra Capsule 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40700035102020","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Sinus Node Inhibitors","drug_name":"Corlanor Solution 5 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"450","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"89150010103905","therapeutic_category":"ANORECTAL AND RELATED PRODUCTS(Medications to treat pain and inflammation in the anus or rectum)","therapeutic_class":"Intrarectal Steroids","drug_name":"Cortifoam Foam 10 % Rectal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"%","route":"Rectal","dose_form":"Foam","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100015100310","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Cortisone Acetate Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Cortizone-10 Eczema Lotion 1 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Cortizone-10 Hydratensive Lotion 1 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Cortizone-10 Ointment 1 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057500E530","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Cosentyx (300 MG Dose) Solution Prefilled Syringe 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057500D530","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Cosentyx Sensoready (300 MG) Solution Auto-Injector 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057500D520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Cosentyx Sensoready Pen Solution Auto-injector 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057500E520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Cosentyx Solution Prefilled Syringe 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057500E510","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Cosentyx Solution Prefilled Syringe 75 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057500D550","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Cosentyx UnoReady Solution Auto-Injector 300 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533530200320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Cotellic TABLET 20 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30321020000145","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Corticotropin-Releasing Factor (CRF) Receptor Type 1 Antag","drug_name":"Crenessity Capsule 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30321020000130","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Corticotropin-Releasing Factor (CRF) Receptor Type 1 Antag","drug_name":"Crenessity Capsule 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30321020002020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Corticotropin-Releasing Factor (CRF) Receptor Type 1 Antag","drug_name":"Crenessity Solution 50 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"51200024006740","therapeutic_category":"DIGESTIVE AIDS (Medications to aid in the digestion of food)","therapeutic_class":"Digestive Enzymes","drug_name":"Creon Capsule Delayed Release Particles 12000-38000 UNIT Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12000-38000","strength_unit_of_measure":"UNIT","route":"Oral","dose_form":"Capsule Delayed Release Particles","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"51200024006760","therapeutic_category":"DIGESTIVE AIDS (Medications to aid in the digestion of food)","therapeutic_class":"Digestive Enzymes","drug_name":"Creon Capsule Delayed Release Particles 24000-76000 UNIT Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"24000-76000","strength_unit_of_measure":"UNIT","route":"Oral","dose_form":"Capsule Delayed Release Particles","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"51200024006705","therapeutic_category":"DIGESTIVE AIDS (Medications to aid in the digestion of food)","therapeutic_class":"Digestive Enzymes","drug_name":"Creon Capsule Delayed Release Particles 3000-9500 UNIT Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3000-9500","strength_unit_of_measure":"UNIT","route":"Oral","dose_form":"Capsule Delayed Release Particles","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"51200024006780","therapeutic_category":"DIGESTIVE AIDS (Medications to aid in the digestion of food)","therapeutic_class":"Digestive Enzymes","drug_name":"Creon Capsule Delayed Release Particles 36000-114000 UNIT Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"36000-114000","strength_unit_of_measure":"UNIT","route":"Oral","dose_form":"Capsule Delayed Release Particles","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"51200024006720","therapeutic_category":"DIGESTIVE AIDS (Medications to aid in the digestion of food)","therapeutic_class":"Digestive Enzymes","drug_name":"Creon Capsule Delayed Release Particles 6000-19000 UNIT Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6000-19000","strength_unit_of_measure":"UNIT","route":"Oral","dose_form":"Capsule Delayed Release Particles","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407030110125","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Cresemba Capsule 186 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"186","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407030110115","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Cresemba Capsule 74.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"170","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"74.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104530200120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Crixivan Capsule 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104530200140","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Crixivan Capsule 400 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44150010102505","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Anti-Inflammatory Agents","drug_name":"Cromolyn Sodium Nebulization Solution 20 MG/2ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/2ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002900310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Cryselle-28 Tablet 0.3-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.3-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30909510602010","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"X-Linked Hypophosphatemia (XLH) Treatment - Agents","drug_name":"Crysvita Solution 10 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30909510602020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"X-Linked Hypophosphatemia (XLH) Treatment - Agents","drug_name":"Crysvita Solution 20 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30909510602030","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"X-Linked Hypophosphatemia (XLH) Treatment - Agents","drug_name":"Crysvita Solution 30 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Curity Alcohol Preps Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97301000000000","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Adhesive Bandages","drug_name":"Curity Wound Closure 1/8\"x3\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45000080111830","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Respiratory Agents - Misc.","drug_name":"Curosurf SUSPENSION 120 MG/1.5ML Intratracheal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG/1.5ML","route":"Intratracheal","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45000080111840","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Respiratory Agents - Misc.","drug_name":"Curosurf SUSPENSION 240 MG/3ML Intratracheal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG/3ML","route":"Intratracheal","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020572021","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cutaquig Solution 1 GM/6ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM/6ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020572025","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cutaquig Solution 1.65 GM/10ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.65","strength_unit_of_measure":"GM/10ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020572030","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cutaquig Solution 2 GM/12ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM/12ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020572035","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cutaquig Solution 3.3 GM/20ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3.3","strength_unit_of_measure":"GM/20ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020572040","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cutaquig Solution 4 GM/24ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM/24ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020572055","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cutaquig Solution 8 GM/48ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"GM/48ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202050","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cuvitru SOLUTION 1 GM/5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM/5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202054","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cuvitru SOLUTION 2 GM/10ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM/10ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202058","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cuvitru SOLUTION 4 GM/20ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM/20ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202062","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Cuvitru SOLUTION 8 GM/40ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"GM/40ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99200020200330","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Chelating Agents","drug_name":"Cuvrior Tablet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104020003710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"CVS 3-Day Vaginal Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"CVS Advantage/Iron Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"CVS All Day Pain Relief Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41550030007220","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"CVS Allergy Relief Tablet Dispersible 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991002050560","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"CVS Antacid & Anti-Gas Tablet Chewable 1000-60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000-60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"CVS Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"CVS Antacid Extra Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"CVS Antacid Maximum Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"CVS Antacid Plus AntiGas Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002301820","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"CVS Antacid Supreme Suspension 400-135 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-135","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"CVS Antacid Ultra Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100105","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"CVS Anti-Diarrheal Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"CVS Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"CVS Aspirin Adult Low Dose Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"CVS Aspirin Adult Low Strength Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"CVS Aspirin EC Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"CVS Aspirin Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"CVS Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"CVS Bacitracin Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"CVS Bacitracin Zinc Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100055000307","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"CVS Backache Relief Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000307","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"CVS Bismuth Tablet 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640357","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"CVS Calcium 600+D Tablet 600-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"CVS Childrens Ibuprofen Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Childs Non-Aspirin Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"CVS Cortisone Maximum Strength Gel 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"CVS Cortisone Maximum Strength Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300060100145","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"CVS Digestive Probiotic Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"CVS Enema Disposable Enema 19-7 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"19-7","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"CVS Enema Disposable Enema 7-19 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7-19","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010005205","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Fever Reducing Childrens Suppository 120 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"CVS Gas Relief Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000910","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"CVS Gas Relief Drops Ex St Liquid 40 MG/0.6ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.6ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"CVS Gas Relief Extra Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"CVS Gas Relief Ultra Strength Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"CVS Gentle Infant Formula/Iron Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"CVS Gentle Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"CVS Gentle Laxative Womens Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030004020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"CVS Glucose Gel 40 % Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"%","route":"Oral","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030000925","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"CVS Glucose Shot Liquid 15 GM/59ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"GM/59ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030000515","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"CVS Glucose Tablet Chewable 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27309902400520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other - Combinations","drug_name":"CVS Glucose Tablet Chewable 4-6 GM-MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4-6","strength_unit_of_measure":"GM-MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78420000000501","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals","drug_name":"CVS Gummy Dinos Tablet Chewable Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"66100020000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"CVS Ibuprofen Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"CVS Ibuprofen Infants Suspension 50 MG/1.25ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/1.25ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"CVS Infant Formula/Iron Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"98365060502910","therapeutic_category":"PHARMACEUTICAL ADJUVANTS (Agents to support the administration of other medications)","therapeutic_class":"Thickening Agents","drug_name":"CVS Instant Food Thickener Powder Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90971501406320","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Skin Cleansers","drug_name":"CVS Isopropyl Alcohol Wipes 70 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":"External","dose_form":null,"multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94109902406100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Multiple Urine Tests","drug_name":"CVS Ketone Care Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90909904506430","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicide Combinations","drug_name":"CVS Lice Solution 3-Step Kit Combination","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Combination","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90909904506420","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicide Combinations","drug_name":"CVS Lice Solution Kit Combination","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Combination","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"CVS Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"CVS Miconazole 7 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"CVS Motion Sickness II Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000510","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"CVS Motion Sickness Relief Tablet Chewable 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"CVS Motion Sickness Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100127","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"CVS Naproxen Sodium Capsule 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"CVS Naproxen Sodium Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"CVS Nicotine Patch 24 Hour 14 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"CVS Nicotine Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"CVS Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002820","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"CVS Nicotine Polacrilex Gum 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"CVS Nicotine Polacrilex Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"CVS Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Non-Aspirin Childrens Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Non-Aspirin Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000515","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Non-Aspirin Jr Tablet Chewable 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000914","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Pain Relief Adult Liquid 500 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"CVS Pain Relief Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79700050000310","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"CVS Potassium Gluconate Tablet 2 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"CVS Purelax Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"CVS Senna Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"CVS Sensitivity/Iron Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"CVS Stomach Relief Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"CVS Tender/Iron Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"CVS Toddler & Infant/Iron Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"CVS Ultra Sleep Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78516020006318","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"CVS Womens Prenatal+DHA 28-0.975 & 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.975 & 200","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"82100010002015","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Cobalamins","drug_name":"Cyanocobalamin Solution 1000 MCG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002500320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Cyclafem 1/35 Tablet 1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25992002200310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Cyclafem 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5/0.75/1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100050100305","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Cyclobenzaprine HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100050100303","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Cyclobenzaprine HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86350020102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Cycloplegic Mydriatics","drug_name":"Cyclopentolate HCl Solution 1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86350020102015","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Cycloplegic Mydriatics","drug_name":"Cyclopentolate HCl Solution 2 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21101020000105","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrogen Mustards and Related Analogues","drug_name":"Cyclophosphamide Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21101020000110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrogen Mustards and Related Analogues","drug_name":"Cyclophosphamide Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21101020000305","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrogen Mustards and Related Analogues","drug_name":"cycloPHOSphamide Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21101020000310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrogen Mustards and Related Analogues","drug_name":"Cyclophosphamide Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402020000140","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"CycloSPORINE CAPSULE 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402020000110","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"CycloSPORINE CAPSULE 25 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86720020001620","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Immunomodulators","drug_name":"cycloSPORINE Emulsion 0.05 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Emulsion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402020300150","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"cycloSPORINE Modified Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402020300120","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"cycloSPORINE Modified Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402020300130","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"cycloSPORINE Modified Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402020302020","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"CycloSPORINE Modified Solution 100 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41500020101210","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Piperidines","drug_name":"Cyproheptadine HCl Syrup 2 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41500020100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Piperidines","drug_name":"Cyproheptadine HCl Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Cyred Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56400030100140","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Cystinosis Agents","drug_name":"Cystagon Capsule 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56400030100120","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Cystinosis Agents","drug_name":"Cystagon Capsule 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86805525102020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmics - Cystinosis Agents","drug_name":"Cystaran Solution 0.44 % Ophthalmic","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.44","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56202022003010","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Citrates","drug_name":"Cytra K Crystals Packet 3300-1002 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3300-1002","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83337030200130","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Thrombin Inhibitors - Selective Direct & Reversible","drug_name":"Dabigatran Etexilate Mesylate Capsule 110 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"110","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83337030200140","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Thrombin Inhibitors - Selective Direct & Reversible","drug_name":"Dabigatran Etexilate Mesylate Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83337030200120","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Thrombin Inhibitors - Selective Direct & Reversible","drug_name":"Dabigatran Etexilate Mesylate Capsule 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62406030007420","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Potassium Channel Blockers","drug_name":"Dalfampridine ER Tablet Extended Release 12 Hour 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"AMPYRA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23100005000110","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Androgens","drug_name":"Danazol Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23100005000115","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Androgens","drug_name":"Danazol Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23100005000105","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Androgens","drug_name":"Danazol Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75200010100115","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Direct Muscle Relaxants","drug_name":"Dantrolene Sodium Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75200010100105","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Direct Muscle Relaxants","drug_name":"Dantrolene Sodium Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75200010100110","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Direct Muscle Relaxants","drug_name":"Dantrolene Sodium Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531860600320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Danziten Tablet 71 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"71","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531860600330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Danziten Tablet 95 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"95","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27700040200320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Dapagliflozin Propanediol Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27700040200310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Dapagliflozin Propanediol Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051015004020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Dapsone Gel 5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051015004030","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Dapsone Gel 7.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16300010000320","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Leprostatics","drug_name":"Dapsone Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16300010000310","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Leprostatics","drug_name":"Dapsone Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990003201830","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Daptacel Suspension 23-15-5 Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"23-15-5","strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16270030002130","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Cyclic Lipopeptides","drug_name":"DAPTOmycin Solution Reconstituted 350 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"350","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16270030002140","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Cyclic Lipopeptides","drug_name":"DAPTOmycin Solution Reconstituted 500 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104520000325","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Darunavir Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104520000350","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Darunavir Tablet 800 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531820000360","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Dasatinib Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531820000380","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Dasatinib Tablet 140 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"140","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531820000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Dasatinib Tablet 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531820000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Dasatinib Tablet 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531820000350","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Dasatinib Tablet 70 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531820000354","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Dasatinib Tablet 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21370030300335","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Hedgehog Pathway Inhibitors","drug_name":"Daurismo Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21370030300320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Hedgehog Pathway Inhibitors","drug_name":"Daurismo Tablet 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Deblitane TABLET 0.35 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100025000330","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferasirox Tablet 180 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100025000340","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferasirox Tablet 360 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"360","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100025000320","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferasirox Tablet 90 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100025007320","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferasirox Tablet Soluble 125 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100025007330","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferasirox Tablet Soluble 250 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100025007340","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferasirox Tablet Soluble 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100028000340","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferiprone Tablet 1000 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93100028000320","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Antidotes - Chelating Agents","drug_name":"Deferiprone Tablet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100017000350","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Deflazacort Tablet 18 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100017000360","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Deflazacort Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100017000365","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Deflazacort Tablet 36 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"36","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100017000340","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Deflazacort Tablet 6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78420000000900","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals","drug_name":"DEKAs Plus Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"99700000002029","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Peritoneal Dialysis Solutions","drug_name":"Delflex-LC/1.5% Dextrose SOLUTION 346 MOSM/L INTRAPERITONEAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"346","strength_unit_of_measure":"MOSM/L","route":"Intraperitoneal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99700000002031","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Peritoneal Dialysis Solutions","drug_name":"Delflex-SM/1.5% Dextrose Solution 347 MOSM/L Intraperitoneal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"347","strength_unit_of_measure":"MOSM/L","route":"Intraperitoneal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99700000002044","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Peritoneal Dialysis Solutions","drug_name":"Delflex-SM/2.5% Dextrose Solution 398 MOSM/L Intraperitoneal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"398","strength_unit_of_measure":"MOSM/L","route":"Intraperitoneal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903270320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Delstrigo Tablet 100-300-300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-300-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Delyla Tablet 0.1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000010100305","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Demeclocycline HCl Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000010100310","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Demeclocycline HCl Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100003101920","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Dengvaxia Suspension Reconstituted Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Subcutaneous","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035101710","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Depo-Estradiol Oil 5 MG/ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Oil","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2515003510E625","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Injectable","drug_name":"Depo-SubQ Provera 104 Suspension Prefilled Syringe 104 MG/0.65ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"104","strength_unit_of_measure":"MG/0.65ML","route":"Subcutaneous","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902290310","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Descovy Tablet 120-15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120-15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902290320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Descovy Tablet 200-25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30201010102015","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Vasopressin","drug_name":"Desmopressin Acetate Solution 1.5 MG/ML Nasal","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG/ML","route":"Nasal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30201010132010","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Vasopressin","drug_name":"Desmopressin Acetate Spray Solution 0.01 % Nasal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.01","strength_unit_of_measure":"%","route":"Nasal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30201010100310","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Vasopressin","drug_name":"Desmopressin Acetate Tablet 0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30201010100320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Vasopressin","drug_name":"Desmopressin Acetate Tablet 0.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Desogestrel-Ethinyl Estradiol Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550035003705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Desonide Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550035004105","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Desonide Lotion 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550035004205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Desonide Ointment 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030000515","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Dex4 Quick Dissolve Glucose Tablet Chewable 4 GM Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020001005","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Dexamethasone Elixir 0.5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Elixir","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020001320","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Dexamethasone Intensol Concentrate 1 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Concentrate","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86300010102005","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroids","drug_name":"Dexamethasone Sodium Phosphate Solution 0.1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020002005","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Dexamethasone SOLUTION 0.5 MG/5ML ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020000315","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"dexAMETHasone Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020000320","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"dexAMETHasone Tablet 0.75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020000325","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"dexAMETHasone Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020000330","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Dexamethasone Tablet 1.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020000335","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"dexAMETHasone Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020000340","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Dexamethasone Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100020000345","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"dexAMETHasone Tablet 6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012026200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"Dexcom G6 Receiver Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"Dexcom G6 Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012066300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"Dexcom G6 Transmitter","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"84"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"Dexcom G7 15 Day Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012026200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"Dexcom G7 Receiver Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"Dexcom G7 Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107030","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107035","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107040","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107045","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107050","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107055","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107060","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016107020","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl ER Capsule Extended Release 24 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016100340","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016100320","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400016100330","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Dexmethylphenidate HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100020107010","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Dextroamphetamine Sulfate ER Capsule Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100020107015","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Dextroamphetamine Sulfate ER Capsule Extended Release 24 Hour 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100020107005","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Dextroamphetamine Sulfate ER Capsule Extended Release 24 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100020102020","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Dextroamphetamine Sulfate Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1800","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100020100310","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Dextroamphetamine Sulfate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100020100305","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Dextroamphetamine Sulfate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Diabetisource AC Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600070000120","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Diacomit Capsule 250 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600070000130","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Diacomit Capsule 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600070003020","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Diacomit Packet 250 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600070003030","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Diacomit Packet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Diamode Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99700000002042","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Peritoneal Dialysis Solutions","drug_name":"Dianeal PD-2/2.5% Dextrose SOLUTION 396 MOSM/L INTRAPERITONEAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"396","strength_unit_of_measure":"MOSM/L","route":"Intraperitoneal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99700000002073","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Peritoneal Dialysis Solutions","drug_name":"Dianeal PD-2/4.25% Dextrose SOLUTION 485 MOSM/L INTRAPERITONEAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"485","strength_unit_of_measure":"MOSM/L","route":"Intraperitoneal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72100030004040","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"diazePAM Gel 10 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72100030004030","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"diazePAM Gel 2.5 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72100030004060","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"diazePAM Gel 20 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100007100330","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Diclofenac Potassium Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100007207530","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Diclofenac Sodium ER Tablet Extended Release 24 Hour 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90210030304020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Anti-inflammatory Agents - Topical","drug_name":"Diclofenac Sodium Gel 1 % Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Transdermal","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86805010102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Nonsteroidal Anti-inflammatory Agents","drug_name":"Diclofenac Sodium Solution 0.1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100007200610","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Diclofenac Sodium Tablet Delayed Release 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100007200620","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Diclofenac Sodium Tablet Delayed Release 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100007200630","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Diclofenac Sodium Tablet Delayed Release 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66109902200620","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agent Combinations","drug_name":"Diclofenac-miSOPROStol Tablet Delayed Release 50-0.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-0.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66109902200630","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agent Combinations","drug_name":"Diclofenac-miSOPROStol Tablet Delayed Release 75-0.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75-0.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01300020100110","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Dicloxacillin Sodium Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01300020100115","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Dicloxacillin Sodium Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49103010100105","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Antispasmodics","drug_name":"Dicyclomine HCl Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49103010102050","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Antispasmodics","drug_name":"Dicyclomine HCl Solution 10 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49103010100305","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Antispasmodics","drug_name":"Dicyclomine HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03530025001920","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fidaxomicin","drug_name":"Dificid Suspension Reconstituted 40 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"136","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03530025000320","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fidaxomicin","drug_name":"Dificid Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100050000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Diflunisal Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86300012001620","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroids","drug_name":"Difluprednate Emulsion 0.05 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Emulsion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"31200010002040","therapeutic_category":"CARDIOTONICS (Medications to help control heart rate)","therapeutic_class":"Cardiac Glycosides","drug_name":"Digoxin Solution 0.05 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"31200010000305","therapeutic_category":"CARDIOTONICS (Medications to help control heart rate)","therapeutic_class":"Cardiac Glycosides","drug_name":"Digoxin Tablet 125 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"31200010000310","therapeutic_category":"CARDIOTONICS (Medications to help control heart rate)","therapeutic_class":"Cardiac Glycosides","drug_name":"Digoxin Tablet 250 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"67000030102005","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Migraine Products","drug_name":"Dihydroergotamine Mesylate Solution 1 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67000030102060","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Migraine Products","drug_name":"Dihydroergotamine Mesylate Solution 4 MG/ML Nasal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG/ML","route":"Nasal","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72200030200105","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Dilantin Capsule 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010117020","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010117030","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010117040","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010117050","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010117060","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Beads Capsule Extended Release 24 Hour 360 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"360","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010117070","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Diltiazem HCl ER Beads Capsule Extended Release 24 Hour 420 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"420","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010106920","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Capsule Extended Release 12 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010106910","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Capsule Extended Release 12 Hour 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010106915","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Capsule Extended Release 12 Hour 90 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107020","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Capsule Extended Release 24 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107030","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Capsule Extended Release 24 Hour 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107040","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Capsule Extended Release 24 Hour 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127020","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127030","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127040","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127050","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010127060","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl ER Coated Beads Capsule Extended Release 24 Hour 360 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"360","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010100320","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl Tablet 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010100305","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010100310","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl Tablet 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010100315","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"dilTIAZem HCl Tablet 90 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107020","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Dilt-XR Capsule Extended Release 24 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107030","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Dilt-XR Capsule Extended Release 24 Hour 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107040","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Dilt-XR Capsule Extended Release 24 Hour 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"dimenhyDRINATE Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62405525006520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Nrf2 Pathway Activators","drug_name":"Dimethyl Fumarate Capsule Delayed Release 120 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62405525006540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Nrf2 Pathway Activators","drug_name":"Dimethyl Fumarate Capsule Delayed Release 240 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240552500B320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Nrf2 Pathway Activators","drug_name":"Dimethyl Fumarate Starter Pack Capsule Delayed Release Therapy Pack 120 & 240 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120 & 240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release Therapy Pack","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100010100310","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Diphenoxylate-Atropine Tablet 2.5-0.025 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-0.025","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990002101810","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Diphtheria-Tetanus Toxoids DT Suspension 25-5 LFU/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-5","strength_unit_of_measure":"LFU/0.5ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85150030000310","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Platelet Aggregation Inhibitors","drug_name":"Dipyridamole Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85150030000320","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Platelet Aggregation Inhibitors","drug_name":"Dipyridamole Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85150030000330","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Platelet Aggregation Inhibitors","drug_name":"Dipyridamole Tablet 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35100010100105","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-A","drug_name":"Disopyramide Phosphate Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35100010100110","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-A","drug_name":"Disopyramide Phosphate Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62802040000325","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Alcohol Deterrents","drug_name":"Disulfiram Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62802040000350","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Alcohol Deterrents","drug_name":"Disulfiram Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100055200320","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Doans Extra Strength Tablet 580 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"580","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46500010100105","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Surfactant Laxatives","drug_name":"Docusate Calcium Capsule 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46500010300120","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Surfactant Laxatives","drug_name":"Docusate Sodium Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46500010300910","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Surfactant Laxatives","drug_name":"Docusate Sodium Liquid 50 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35400025000110","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Dofetilide Capsule 125 MCG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35400025000120","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Dofetilide Capsule 250 MCG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35400025000130","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Dofetilide Capsule 500 MCG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"80200080000920","therapeutic_category":"NUTRIENTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Lipids","drug_name":"Dojolvi Liquid 100 % Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"%","route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46500010300305","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Surfactant Laxatives","drug_name":"DOK Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051025100320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Donepezil HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051025100330","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Donepezil HCl Tablet 23 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"23","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051025100310","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Donepezil HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051025107220","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Donepezil HCl Tablet Dispersible 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051025107210","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Donepezil HCl Tablet Dispersible 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405010206820","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Doptelet Sprinkle Capsule Sprinkle 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405010200320","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Doptelet Tablet 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"15","quantity_limit_days":"35"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86802340102020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Carbonic Anhydrase Inhibitors","drug_name":"Dorzolamide HCl Solution 2 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86259902202020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Beta-blockers - Ophthalmic Combinations","drug_name":"Dorzolamide HCl-Timolol Mal Solution 2-0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2-0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12109902260320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Dovato Tablet 50-300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36202005100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Peripherally Acting","drug_name":"Doxazosin Mesylate Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36202005100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Peripherally Acting","drug_name":"Doxazosin Mesylate Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36202005100330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Peripherally Acting","drug_name":"Doxazosin Mesylate Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36202005100340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Peripherally Acting","drug_name":"Doxazosin Mesylate Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"30905040000105","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Doxercalciferol Capsule 0.5 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905040000110","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Doxercalciferol Capsule 1 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905040000120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Doxercalciferol Capsule 2.5 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020100110","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Hyclate Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020100105","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Hyclate Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020102105","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Hyclate Solution Reconstituted 100 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020100310","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Hyclate Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020100302","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Hyclate Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020100610","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Hyclate Tablet Delayed Release 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020000110","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Monohydrate Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020000105","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Monohydrate Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020001905","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Monohydrate Suspension Reconstituted 25 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020000310","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Monohydrate Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020000315","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Monohydrate Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020000305","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Monohydrate Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000020000307","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Doxycycline Monohydrate Tablet 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50309902100620","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetic Combinations","drug_name":"Doxylamine-Pyridoxine Tablet Delayed Release 10-10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Dramamine Less Drowsy Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Driminate Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50300030000120","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Miscellaneous","drug_name":"Dronabinol Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50300030000110","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Miscellaneous","drug_name":"Dronabinol Capsule 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50300030000115","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Miscellaneous","drug_name":"Dronabinol Capsule 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003200320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Drospiren-Eth Estrad-Levomefol Tablet 3-0.02-0.451 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3-0.02-0.451","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002150320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Drospirenone-Ethinyl Estradiol Tablet 3-0.03 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3-0.03","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82803030000120","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Cytotoxic Agents","drug_name":"Droxia Capsule 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82803030000130","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Cytotoxic Agents","drug_name":"Droxia Capsule 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82803030000140","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Cytotoxic Agents","drug_name":"Droxia Capsule 400 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Dulcolax Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902903220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Dulera Aerosol 100-5 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902903240","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Dulera Aerosol 200-5 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902903210","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Dulera Aerosol 50-5 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Duocal Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"9027302000D515","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Dupixent Solution Auto-Injector 200 MG/1.14ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/1.14ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027302000D520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Dupixent Solution Auto-Injector 300 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027302000D215","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Dupixent Solution Pen-Injector 200 MG/1.14ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/1.14ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027302000D220","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Dupixent Solution Pen-Injector 300 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027302000E510","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Dupixent Solution Prefilled Syringe 100 MG/0.67ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.34","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/0.67ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027302000E515","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Dupixent Solution Prefilled Syringe 200 MG/1.14ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/1.14ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9027302000E520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Monoclonal Antibodies","drug_name":"Dupixent Solution Prefilled Syringe 300 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97401020106200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Condoms - Male","drug_name":"Durex RealFeel Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56851020000120","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"5-Alpha Reductase Inhibitors","drug_name":"Dutasteride Capsule 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"EasiVent","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"EasiVent Mask Large","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"EasiVent Mask Medium","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"EasiVent Mask Small","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051030906329","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Comfort Insulin Syringe 30G X 1/2\" 0.5 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30G X 1/2\"","strength_unit_of_measure":"0.5 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051030906386","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Comfort Insulin Syringe 30G X 1/2\" 1 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30G X 1/2\"","strength_unit_of_measure":"1 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051030906328","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Comfort Insulin Syringe 30G X 5/16\" 0.5 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30G X 5/16\"","strength_unit_of_measure":"0.5 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051030906384","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Comfort Insulin Syringe 30G X 5/16\" 1 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30G X 5/16\"","strength_unit_of_measure":"1 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Comfort Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Comfort Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Easy Touch Alcohol Prep Medium Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036310","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch FlipLock Safety Syr 18G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch FlipLock Safety Syr 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Pen Needles 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146367","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Pen Needles 32G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146368","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Pen Needles 32G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Safety Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036350","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Safety Syringe 22G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036360","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch Safety Syringe 22G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Easy Touch SheathLock Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020256330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"EasyPoint Needle 25G X 1-1/2\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25G X 1-1/2\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Ecotrin Low Strength Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000912","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Ed-APAP Liquid 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109080107320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Edurant PED Tablet Soluble 2.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109080100320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Edurant Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109030000140","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Efavirenz Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109030000110","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Efavirenz Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109030000330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Efavirenz Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903300320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Efavirenz-Emtricitab-Tenofo DF Tablet 600-200-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-200-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903300320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Efavirenz-Emtricitab-Tenofovir Tablet 600-200-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-200-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903330330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Efavirenz-lamiVUDine-Tenofovir Tablet 400-300-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-300-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903330340","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Efavirenz-lamiVUDine-Tenofovir Tablet 600-300-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-300-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64109902110820","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylate Combinations","drug_name":"Effervescent Pain Relief Tablet Effervescent 325-1000-1916 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325-1000-1916","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Effervescent","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"EleCare DHA/ARA Infant Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"EleCare DHA/ARA Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"EleCare Jr Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"EleCare Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"67406025100320","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Eletriptan Hydrobromide Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406025100340","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Eletriptan Hydrobromide Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010156432","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Eligard Kit 22.5 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22.5","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010206435","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Eligard Kit 30 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010256445","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Eligard Kit 45 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010106415","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Eligard Kit 7.5 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83370010000330","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Direct Factor Xa Inhibitors","drug_name":"Eliquis DVT/PE Starter Pack Tablet 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83370010000320","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Direct Factor Xa Inhibitors","drug_name":"Eliquis Tablet 2.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83370010000330","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Direct Factor Xa Inhibitors","drug_name":"Eliquis Tablet 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25400070100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Emergency Contraceptives","drug_name":"Ella Tablet 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56500060100110","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Interstitial Cystitis Agents","drug_name":"Elmiron Capsule 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030100310","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Eltrombopag Olamine Tablet 12.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030100320","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Eltrombopag Olamine Tablet 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030100330","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Eltrombopag Olamine Tablet 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030100340","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Eltrombopag Olamine Tablet 75 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25970002309020","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Vaginal","drug_name":"EluRyng Ring 0.12-0.015 MG/24HR Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.12-0.015","strength_unit_of_measure":"MG/24HR","route":"Vaginal","dose_form":"Ring","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21403020100105","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Estrogens-Antineoplastic","drug_name":"Emcyt Capsule 140 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"140","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50280020001930","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Substance P/Neurokinin 1 (NK1) Receptor Antagonists","drug_name":"Emend Suspension Reconstituted 125 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6770203530E515","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"CGRP Receptor Antagonists - Monocolonal Antibodies","drug_name":"Emgality (300 MG Dose) Solution Prefilled Syringe 100 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6770203530D520","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"CGRP Receptor Antagonists - Monocolonal Antibodies","drug_name":"Emgality Solution Auto-Injector 120 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6770203530E520","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"CGRP Receptor Antagonists - Monocolonal Antibodies","drug_name":"Emgality Solution Prefilled Syringe 120 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Emoquette Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85804065002020","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Complement C3 Inhibitors","drug_name":"Empaveli Solution 1080 MG/20ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1080","strength_unit_of_measure":"MG/20ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12106030000120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Pyrimidines","drug_name":"Emtricitabine Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902300308","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Emtricitabine-Tenofovir DF Tablet 100-150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902300312","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Emtricitabine-Tenofovir DF Tablet 133-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"133-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902300316","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Emtricitabine-Tenofovir DF Tablet 167-250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"167-250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902300320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903400320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Emtricitab-Rilpivir-Tenofov DF Tablet 200-25-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-25-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12106030002010","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Pyrimidines","drug_name":"Emtriva SOLUTION 10 MG/ML ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000010000505","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Emverm Tablet Chewable 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Emzahh Tablet 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100020102020","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Enalapril Maleate Solution 1 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100020100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Enalapril Maleate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100020100303","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Enalapril Maleate Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100020100315","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Enalapril Maleate Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100020100305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Enalapril Maleate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802350310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Enalapril-Hydrochlorothiazide Tablet 10-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802350305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Enalapril-Hydrochlorothiazide Tablet 5-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"6629003000E230","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Soluble Tumor Necrosis Factor Receptor Agents","drug_name":"Enbrel Mini Solution Cartridge 50 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6629003000E525","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Soluble Tumor Necrosis Factor Receptor Agents","drug_name":"Enbrel Solution Prefilled Syringe 25 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ENBREL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6629003000E530","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Soluble Tumor Necrosis Factor Receptor Agents","drug_name":"Enbrel Solution Prefilled Syringe 50 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ENBREL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6629003000D530","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Soluble Tumor Necrosis Factor Receptor Agents","drug_name":"Enbrel SureClick Solution Auto-Injector 50 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ENBREL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55300010005210","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Spermicides","drug_name":"Encare Suppository 100 MG Vaginal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Vaginal","dose_form":"Suppository","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65990002200335","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"Endocet Tablet 10-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65990002200305","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"Endocet Tablet 2.5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65990002200310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"Endocet Tablet 5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65990002200327","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"Endocet Tablet 7.5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000440","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Endur-Acin Tablet Extended Release 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000450","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Endur-Acin Tablet Extended Release 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"Enema Disposable Enema Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"Enema Enema 7-19 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7-19","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"Enema Enema Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfagrow Next Step Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfagrow Next Step Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfagrow Premium LIPIL Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfagrow Premium Older Toddler Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfamil 24 Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfamil AR Spit-Up Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfamil EnfaCare Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfamil Gentlease Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfamil Human Milk Fortifier Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Enfaport Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17100010202210","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Engerix-B Injectable 10 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100010202230","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Engerix-B Injectable 20 MCG/ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MCG/ML","route":"Intramuscular","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100010201827","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Engerix-B Suspension 10 MCG/0.5ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100010201830","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Engerix-B Suspension 20 MCG/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710001020E625","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Engerix-B Suspension Prefilled Syringe 10 MCG/0.5ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710001020E630","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Engerix-B Suspension Prefilled Syringe 20 MCG/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102016","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 100 MG/ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102018","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 120 MG/0.8ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102020","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 150 MG/ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102012","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 30 MG/0.3ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/0.3ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102050","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 300 MG/3ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/3ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102013","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 40 MG/0.4ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102014","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 60 MG/0.6ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/0.6ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101020102015","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution 80 MG/0.8ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310102010E540","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution Prefilled Syringe 100 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310102010E560","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution Prefilled Syringe 120 MG/0.8ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG/0.8ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310102010E565","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution Prefilled Syringe 150 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310102010E520","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution Prefilled Syringe 30 MG/0.3ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/0.3ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310102010E525","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution Prefilled Syringe 40 MG/0.4ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.4ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310102010E530","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution Prefilled Syringe 60 MG/0.6ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/0.6ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310102010E535","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Enoxaparin Sodium Solution Prefilled Syringe 80 MG/0.8ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG/0.8ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25992002100310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Enpresse-28 Tablet 50-30/75-40/ 125-30 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-30/75-40/","strength_unit_of_measure":"125-30 MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533015200140","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Ensacove Capsule 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533015200120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Ensacove Capsule 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Enskyce Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9940507040E520","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Monoclonal Antibodies","drug_name":"Enspryng Solution Prefilled Syringe 120 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Ensure Clear Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Ensure Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Ensure Original Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Ensure Plus Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73153030000320","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Peripheral COMT Inhibitors","drug_name":"Entacapone Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12352030000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis B Agents","drug_name":"Entecavir Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12352030000330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis B Agents","drug_name":"Entecavir Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40992002606830","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Neprilysin Inhib (ARNI)-Angiotensin II Recept Antag Comb","drug_name":"Entresto Capsule Sprinkle 15-16 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15-16","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40992002606820","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Neprilysin Inhib (ARNI)-Angiotensin II Recept Antag Comb","drug_name":"Entresto Capsule Sprinkle 6-6 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6-6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52400020002010","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Intestinal Acidifiers","drug_name":"Enulose Solution 10 GM/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM/15ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12359902653020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agent - Combinations","drug_name":"Epclusa Packet 150-37.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150-37.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12359902653030","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agent - Combinations","drug_name":"Epclusa Packet 200-50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12359902650320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agent - Combinations","drug_name":"Epclusa Tablet 200-50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600017002020","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Epidiolex Solution 100 MG/ML Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3800003200E522","therapeutic_category":"VASOPRESSORS (Medications to increase blood pressure)","therapeutic_class":"Vasopressors","drug_name":"EPINEPHrine PF Solution Prefilled Syringe 1 MG/10ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/10ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3890004000D530","therapeutic_category":"VASOPRESSORS (Medications to increase blood pressure)","therapeutic_class":"Anaphylaxis Therapy Agents","drug_name":"EPINEPHrine Solution Auto-Injector 0.15 MG/0.15ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"90"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15","strength_unit_of_measure":"MG/0.15ML","route":"Injection","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3890004000D520","therapeutic_category":"VASOPRESSORS (Medications to increase blood pressure)","therapeutic_class":"Anaphylaxis Therapy Agents","drug_name":"EPINEPHrine Solution Auto-Injector 0.15 MG/0.3ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"90"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15","strength_unit_of_measure":"MG/0.3ML","route":"Injection","dose_form":"Solution Auto-Injector","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3890004000D540","therapeutic_category":"VASOPRESSORS (Medications to increase blood pressure)","therapeutic_class":"Anaphylaxis Therapy Agents","drug_name":"EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"90"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"MG/0.3ML","route":"Injection","dose_form":"Solution Auto-Injector","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36250030000320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Selective Aldosterone Receptor Antagonists (SARAs)","drug_name":"Eplerenone Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36250030000330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Selective Aldosterone Receptor Antagonists (SARAs)","drug_name":"Eplerenone Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"82401020002040","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Epogen Solution 10000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002010","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Epogen Solution 2000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002050","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Epogen Solution 20000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002015","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Epogen Solution 3000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Epogen Solution 4000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36150024200330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Eprosartan Mesylate Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12109902200340","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Epzicom Tablet 600-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007210","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQ Acetaminophen Childrens Tablet Dispersible 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQ Acetaminophen Junior Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQ Acetaminophen Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64109902110820","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylate Combinations","drug_name":"EQ Antacid & Pain Relief Tablet Effervescent 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Effervescent","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002150520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"EQ Antacid Extra Strength Tablet Chewable 160-105 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160-105","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002300550","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"EQ Antacid Extra Strength Tablet Chewable 675-135 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"675-135","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"EQ Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003101835","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"EQ Antacid Maximum Strength Suspension 400-400-40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-400-40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"EQ Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"EQ Antacid Ultra Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100105","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"EQ Anti-Diarrheal Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100905","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"EQ Anti-Diarrheal Liquid 1 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"EQ Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQ Arthritis Pain Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"EQ Aspirin Adult Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"EQ Aspirin Low Dose Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"EQ Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000607","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"EQ Aspirin Tablet Delayed Release 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQ Childrens Pain Reliever Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"EQ Enema Enema 19-7 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"19-7","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"EQ Gas Relief Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"EQ Gas Relief Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"EQ Gentle Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"EQ Hydrocortisone Max St Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"66100020000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"EQ Ibuprofen Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"EQ Ibuprofen Childrens Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"EQ Ibuprofen Junior Tablet Chewable 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"EQ Infants Gas Relief Suspension 40 MG/0.6ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.6ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270040006510","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"EQ Lansoprazole Capsule Delayed Release 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"EQ Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106410","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"EQ Miconazole 3 Combo Pack Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"EQ Miconazole 7 Day Treatment Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"EQ Motion Sickness Relief Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"EQ Motion Sickness Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"EQ Naproxen Sodium Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"EQ Natural Vegetable Laxative Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Patch 24 Hour 14 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Patch 24 Hour 21 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002820","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Polacrilex Gum 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Polacrilex Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQ Nicotine Step 3 Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270060106520","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"EQ Omeprazole Magnesium Capsule Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270060000620","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"EQ Omeprazole Tablet Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQ Pain & Fever Childrens Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000515","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQ Pain Reliever Junior Tablet Chewable 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"EQ Pink-Bismuth Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010001805","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"EQ Stomach Relief Suspension 262 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"EQ Stomach Relief Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"EQ Vegetable Laxative Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQL Acetaminophen Rapid Tabs Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"EQL Acetaminophen Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"EQL Antacid Ultra Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64109902110820","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylate Combinations","drug_name":"EQL Antacid/Pain Relief Tablet Effervescent 325-1000-1916 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325-1000-1916","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Effervescent","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"EQL Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"EQL Anti-Itch Maximum Strength Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"EQL Aspirin EC Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"EQL Aspirin Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"EQL Bacitracin Zinc Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640152","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"EQL Calcium/Vitamin D Capsule 600-2.5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-2.5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"EQL Calcium/Vitamin D Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"EQL Childrens Ibuprofen Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"EQL Gas Gone Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"EQL Gas Relief Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"EQL Ibuprofen Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"EQL Ibuprofen Infants Suspension 50 MG/1.25ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/1.25ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200325","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"EQL Laxative Maximum Strength Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"EQL Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"EQL Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106410","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"EQL Miconazole 3 Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"EQL Miconazole 7 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQL Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQL Nicotine Polacrilex Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"EQL Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"EQL Ready-to-Use Enema Enema 7-19 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7-19","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"EQL Senna Laxative Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77202030000110","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin D","drug_name":"Ergocalciferol Capsule 1.25 MG (50000 UT) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25 MG","strength_unit_of_measure":"(50000 UT)","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62000010000310","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Psychotherapeutic and Neurological Agents - Misc.","drug_name":"Ergoloid Mesylates Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21370070000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Hedgehog Pathway Inhibitors","drug_name":"Erivedge CAPSULE 150 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ERIVEDGE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21402410000360","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiandrogens","drug_name":"Erleada Tablet 240 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402410000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiandrogens","drug_name":"Erleada TABLET 60 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21360025100330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Erlotinib HCl Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21360025100360","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Erlotinib HCl Tablet 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21360025100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Erlotinib HCl Tablet 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Errin Tablet 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100005000605","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Ery-Tab Tablet Delayed Release 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100005000610","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Ery-Tab Tablet Delayed Release 333 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"333","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100005000615","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Ery-Tab Tablet Delayed Release 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100010100305","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Erythrocin Stearate Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100005006720","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Erythromycin Base Capsule Delayed Release Particles 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release Particles","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100005000305","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Erythromycin Base Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100005000310","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Erythromycin Base Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100030301910","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Erythromycin Ethylsuccinate Suspension Reconstituted 200 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 6 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03100030300305","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Erythromycins","drug_name":"Erythromycin Ethylsuccinate Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051020004010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Erythromycin Gel 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101025004210","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Erythromycin Ointment 5 MG/GM Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/GM","route":"Ophthalmic","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90051020002010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Antibiotics","drug_name":"Erythromycin Solution 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"PA applies above age range","protected_class":false,"emergency_fill":false},{"gpi":"78450000000507","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multi Vitamins w/Fl & FE","drug_name":"Escavite Tablet Chewable 0.25-7.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-7.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270025106520","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Esomeprazole Magnesium Capsule Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270025106540","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Esomeprazole Magnesium Capsule Delayed Release 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270025103010","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Esomeprazole Magnesium Packet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 6 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270025103020","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Esomeprazole Magnesium Packet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 6 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270025103040","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Esomeprazole Magnesium Packet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 6 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002950310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Estarylla Tablet 0.25-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55350020003705","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Estrogens","drug_name":"Estradiol Cream 0.01 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.01","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"55350020003705","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Estrogens","drug_name":"Estradiol Cream 0.1 MG/GM Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG/GM","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"24000035008705","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Twice Weekly 0.025 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.025","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Twice Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008710","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Twice Weekly 0.0375 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.0375","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Twice Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008720","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Twice Weekly 0.05 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Twice Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008730","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Twice Weekly 0.075 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.075","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Twice Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008750","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Twice Weekly 0.1 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Twice Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008810","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Weekly 0.025 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.025","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008815","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Weekly 0.0375 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.0375","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008820","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Weekly 0.05 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008824","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Weekly 0.06 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.06","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008830","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Weekly 0.075 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.075","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035008840","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Patch Weekly 0.1 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch Weekly","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035000303","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035000305","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55350020000310","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Estrogens","drug_name":"Estradiol Tablet 10 MCG Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG","route":"Vaginal","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035000310","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035201705","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Valerate Oil 10 MG/ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Oil","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035201710","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Valerate Oil 20 MG/ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Oil","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000035201715","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Estradiol Valerate Oil 40 MG/ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Oil","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120305","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Estradiol-Norethindrone Acet Tablet 0.5-0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5-0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120310","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Estradiol-Norethindrone Acet Tablet 1-0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60204035000320","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Non-Benzodiazepine - GABA-Receptor Modulators","drug_name":"Eszopiclone Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60204035000330","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Non-Benzodiazepine - GABA-Receptor Modulators","drug_name":"Eszopiclone Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60204035000340","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Non-Benzodiazepine - GABA-Receptor Modulators","drug_name":"Eszopiclone Tablet 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000040100305","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Ethambutol HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000040100310","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Ethambutol HCl Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72400010000105","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Succinimides","drug_name":"Ethosuximide Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72400010002005","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Succinimides","drug_name":"Ethosuximide Solution 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90851005003200","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Topical Anesthetic Gases","drug_name":"Ethyl Chloride Aerosol External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"External","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002200310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Ethynodiol Diac-Eth Estradiol Tablet 1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002200320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Ethynodiol Diac-Eth Estradiol Tablet 1-50 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-50","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30042040100305","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Bisphosphonates","drug_name":"Etidronate Disodium Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30042040100310","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Bisphosphonates","drug_name":"Etidronate Disodium Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100008000120","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Etodolac Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100008000130","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Etodolac Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100008007520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Etodolac ER Tablet Extended Release 24 Hour 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100008007530","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Etodolac ER Tablet Extended Release 24 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100008007540","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Etodolac ER Tablet Extended Release 24 Hour 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100008000310","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Etodolac Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100008000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Etodolac Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25970002309020","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Vaginal","drug_name":"Etonogestrel-Ethinyl Estradiol Ring 0.12-0.015 MG/24HR Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.12-0.015","strength_unit_of_measure":"MG/24HR","route":"Vaginal","dose_form":"Ring","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21500010000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Mitotic Inhibitors","drug_name":"Etoposide Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109035000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Etravirine Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109035000340","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Etravirine Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"28100010100320","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 100 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100322","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 112 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"112","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100325","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 125 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100327","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 137 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"137","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100330","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 150 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100335","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 175 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"175","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100340","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 200 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100305","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 25 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 50 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100315","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 75 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100317","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Euthyrox Tablet 88 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"88","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Evac-U-Gen Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3004486010E520","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Sclerostin Inhibitors","drug_name":"Evenity Solution Prefilled Syringe 105 MG/1.17ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"105","strength_unit_of_measure":"MG/1.17ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99404035000320","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Everolimus Tablet 0.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99404035000325","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Everolimus Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99404035000330","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Everolimus Tablet 0.75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99404035000335","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Everolimus Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532530000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - mTOR Kinase Inhibitors","drug_name":"Everolimus Tablet 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532530000310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - mTOR Kinase Inhibitors","drug_name":"Everolimus Tablet 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532530000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - mTOR Kinase Inhibitors","drug_name":"Everolimus Tablet 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532530000325","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - mTOR Kinase Inhibitors","drug_name":"Everolimus Tablet 7.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"12109902220330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Evotaz Tablet 300-150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300-150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"74706560002120","therapeutic_category":"NEUROMUSCULAR AGENTS (Medications to treat neuromuscular conditions)","therapeutic_class":"Spinal Muscular Atrophy-SMN2 Splicing Modifiers","drug_name":"Evrysdi Solution Reconstituted 0.75 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.75","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"74706560000320","therapeutic_category":"NEUROMUSCULAR AGENTS (Medications to treat neuromuscular conditions)","therapeutic_class":"Spinal Muscular Atrophy-SMN2 Splicing Modifiers","drug_name":"Evrysdi Tablet 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402835000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Aromatase Inhibitors","drug_name":"Exemestane Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717002000D240","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Exenatide Solution Pen-Injector 10 MCG/0.04ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.40","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/0.04ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717002000D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Exenatide Solution Pen-Injector 5 MCG/0.02ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MCG/0.02ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200325","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Ex-Lax Maximum Strength Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Ex-Lax Ultra Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78516038000160","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"Extra-Virt Plus DHA Capsule 29-1.25-350 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1.25-350","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39300030000320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Intestinal Cholesterol Absorption Inhibitors","drug_name":"Ezetimibe Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39994002300320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Intest Cholest Absorp Inhib-HMG CoA Reductase Inhib Comb","drug_name":"Ezetimibe-Simvastatin Tablet 10-10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39994002300330","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Intest Cholest Absorp Inhib-HMG CoA Reductase Inhib Comb","drug_name":"Ezetimibe-Simvastatin Tablet 10-20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39994002300340","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Intest Cholest Absorp Inhib-HMG CoA Reductase Inhib Comb","drug_name":"Ezetimibe-Simvastatin Tablet 10-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39994002300350","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Intest Cholest Absorp Inhib-HMG CoA Reductase Inhib Comb","drug_name":"Ezetimibe-Simvastatin Tablet 10-80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512068000175","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"EzFe Forte Capsule 155-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"155-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"85807535200130","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Complement Factor B Inhibitors","drug_name":"Fabhalta Capsule 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Falmina TABLET 0.1-20 MG-MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12408040000305","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Thymidine Analogues","drug_name":"Famciclovir Tablet 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Valacyclovir","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12408040000310","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Thymidine Analogues","drug_name":"Famciclovir Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Valacyclovir","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"68","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12408040000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Herpes Agents - Thymidine Analogues","drug_name":"Famciclovir Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Valacyclovir","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"42","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49200030001920","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Famotidine Suspension Reconstituted 40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200030000320","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Famotidine Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200030000340","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Famotidine Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"4460402000D520","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Interleukin-5 Antagonists (IgG1 kappa)","drug_name":"Fasenra Pen Solution Auto-Injector 30 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"56"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4460402000E515","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Interleukin-5 Antagonists (IgG1 kappa)","drug_name":"Fasenra Solution Prefilled Syringe 10 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4460402000E520","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Interleukin-5 Antagonists (IgG1 kappa)","drug_name":"Fasenra Solution Prefilled Syringe 30 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"56"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97401510000000","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Condoms - Female","drug_name":"FC2 Female Condom","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"68000030000320","therapeutic_category":"GOUT AGENTS (Medications to treat gout)","therapeutic_class":"Gout Agents","drug_name":"Febuxostat Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"68000030000330","therapeutic_category":"GOUT AGENTS (Medications to treat gout)","therapeutic_class":"Gout Agents","drug_name":"Febuxostat Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72120020001810","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Carbamates","drug_name":"Felbamate Suspension 600 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72120020000310","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Carbamates","drug_name":"Felbamate Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72120020000320","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Carbamates","drug_name":"Felbamate Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000013007520","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Felodipine ER Tablet Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000013007505","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Felodipine ER Tablet Extended Release 24 Hour 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000013007510","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Felodipine ER Tablet Extended Release 24 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97401810006222","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Cervical Caps","drug_name":"FemCap DEVICE 22 MM VAGINAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22","strength_unit_of_measure":"MM","route":"Vaginal","dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97401810006226","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Cervical Caps","drug_name":"FemCap DEVICE 26 MM VAGINAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"26","strength_unit_of_measure":"MM","route":"Vaginal","dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97401810006230","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Cervical Caps","drug_name":"FemCap DEVICE 30 MM VAGINAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MM","route":"Vaginal","dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002607220","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Femlyv Tablet Dispersible 1-0.02 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-0.02","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39200025100114","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Micronized Capsule 130 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"130","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025100115","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Micronized Capsule 134 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"134","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025100130","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Micronized Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025100104","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Micronized Capsule 43 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"43","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025100107","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Micronized Capsule 67 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"67","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025000323","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Tablet 145 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"145","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025000325","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Tablet 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025000310","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Tablet 48 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"48","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200025000312","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibrate Tablet 54 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"54","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200006006540","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibric Acid Capsule Delayed Release 135 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"135","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200006006520","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibric Acid Capsule Delayed Release 45 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39200024000320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Fenofibric Acid Tablet 35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"65100025108475","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Citrate Lozenge On A Handle 1200 MCG Buccal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORAL-INTRANASAL FENTANYL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1200","strength_unit_of_measure":"MCG","route":"Buccal","dose_form":"Lozenge On A Handle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100025108485","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Citrate Lozenge On A Handle 1600 MCG Buccal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORAL-INTRANASAL FENTANYL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1600","strength_unit_of_measure":"MCG","route":"Buccal","dose_form":"Lozenge On A Handle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100025108450","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Citrate Lozenge On A Handle 200 MCG Buccal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORAL-INTRANASAL FENTANYL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"150","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG","route":"Buccal","dose_form":"Lozenge On A Handle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100025108455","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Citrate Lozenge On A Handle 400 MCG Buccal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORAL-INTRANASAL FENTANYL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MCG","route":"Buccal","dose_form":"Lozenge On A Handle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100025108460","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Citrate Lozenge On A Handle 600 MCG Buccal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORAL-INTRANASAL FENTANYL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MCG","route":"Buccal","dose_form":"Lozenge On A Handle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100025108465","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Citrate Lozenge On A Handle 800 MCG Buccal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORAL-INTRANASAL FENTANYL"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MCG","route":"Buccal","dose_form":"Lozenge On A Handle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100025008650","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Patch 72 Hour 100 MCG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/HR","route":"Transdermal","dose_form":"Patch 72 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100025008610","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Patch 72 Hour 12 MCG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12","strength_unit_of_measure":"MCG/HR","route":"Transdermal","dose_form":"Patch 72 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100025008620","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Patch 72 Hour 25 MCG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG/HR","route":"Transdermal","dose_form":"Patch 72 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100025008630","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Patch 72 Hour 50 MCG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/HR","route":"Transdermal","dose_form":"Patch 72 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100025008640","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"fentaNYL Patch 72 Hour 75 MCG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MCG/HR","route":"Transdermal","dose_form":"Patch 72 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"82300030000310","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferretts Tablet 325 (106 Fe) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325 (106 Fe)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300020000308","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Gluconate Tablet 240 (27 Fe) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240 (27 Fe)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300020000319","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Gluconate Tablet 324 (38 Fe) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"324 (38 Fe)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010001010","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate Elixir 220 (44 Fe) MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220 (44 Fe)","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Elixir","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010000454","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate ER Tablet Extended Release 140 (45 Fe) MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"140 (45 Fe)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010000453","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate ER Tablet Extended Release 45 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010002030","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate Solution 220 (44 Fe) MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220 (44 Fe)","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010002041","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate Solution 300 (60 Fe) MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300 (60 Fe)","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010001210","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate Syrup 300 (60 Fe) MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300 (60 Fe)","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010000629","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate Tablet Delayed Release 324 (65 Fe) MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"324 (65 Fe)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010000630","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Ferrous Sulfate Tablet Delayed Release 325 (65 Fe) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325 (65 Fe)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010005205","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Fever Reducer Childrens Suppository 120 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010002003","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Fe-Vite Iron Solution 75 (15 Fe) MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75 (15 Fe)","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"03530025000320","therapeutic_category":"MACROLIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fidaxomicin","drug_name":"Fidaxomicin Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Fifty50 Alcohol Prep Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Fifty50 Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Fifty50 Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56483065000320","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"IgAN Agents - Endothelin & Angiotensin II Receptor Antag","drug_name":"Filspari Tablet 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56483065000340","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"IgAN Agents - Endothelin & Angiotensin II Receptor Antag","drug_name":"Filspari Tablet 400 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56851030000320","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"5-Alpha Reductase Inhibitors","drug_name":"Finasteride Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202025006300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"Fingerstix Lancets","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62407025100120","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Fingolimod HCl Capsule 0.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600028102020","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Fintepla Solution 2.2 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"360","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.2","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"76000012100320","therapeutic_category":"ANTIMYASTHENIC/CHOLINERGIC AGENTS (Medications to treat certain neuromuscular conditions)","therapeutic_class":"Antimyasthenic/Cholinergic Agents","drug_name":"Firdapse Tablet 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270060001820","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"First-Omeprazole Suspension 2 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 6 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"55370060005210","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Progestins","drug_name":"First-Progesterone VGS 100 SUPPOSITORY 100 MG VAGINAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Vaginal","dose_form":"Suppository","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55370060005220","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Progestins","drug_name":"First-Progesterone VGS 200 SUPPOSITORY 200 MG VAGINAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Vaginal","dose_form":"Suppository","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16280080102010","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Glycopeptides","drug_name":"First-Vancomycin 25 Solution 25 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16280080102020","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Glycopeptides","drug_name":"First-Vancomycin 50 Solution 50 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16280080102160","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Glycopeptides","drug_name":"Firvanq Solution Reconstituted 25 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Vancomycin","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16280080102170","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Glycopeptides","drug_name":"Firvanq Solution Reconstituted 50 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Vancomycin","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54400025100310","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodics - Direct Muscle Relaxants","drug_name":"FlavoxATE HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35300010100305","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Flecainide Acetate Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35300010100310","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Flecainide Acetate Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35300010100303","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Flecainide Acetate Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78420000000501","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals","drug_name":"Flintstones Gummies Complete Tablet Chewable Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78420000000501","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals","drug_name":"Flintstones Gummies-Immunity Tablet Chewable Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78412000000500","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Pediatric Multiple Vitamins w/ C & FA","drug_name":"Flintstones/My First Tablet Chewable with C & FA Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"with C & FA","strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Floranex Tablet Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94101024356400","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Infection Tests","drug_name":"Flowflex COVID-19 Ag Home Test Kit In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002047E420","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluad Quadrivalent Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002025E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluarix Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100020852000","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Flublok Solution Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100020821800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Flucelvax Quadrivalent Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002082E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Flucelvax Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407015001910","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Fluconazole Suspension Reconstituted 10 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407015001940","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Fluconazole Suspension Reconstituted 40 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407015000320","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Fluconazole Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407015000325","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Fluconazole Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407015000330","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Fluconazole Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407015000310","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Fluconazole Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000020000105","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Flucytosine Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000020000110","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Flucytosine Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22200030100305","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Mineralocorticoids","drug_name":"Fludrocortisone Acetate Tablet 0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100020251800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Flulaval Quadrivalent Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002025E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Flulaval Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100020541800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"FluMist Quadrivalent Suspension Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Nasal","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87300018101720","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Steroids","drug_name":"Fluocinolone Acetonide Oil 0.01 % Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.01","strength_unit_of_measure":"%","route":"Otic","dose_form":"Oil","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550060003705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Fluocinonide Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550060004205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Fluocinonide Ointment 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550060002005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Fluocinonide Solution 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79300020002039","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Fluorabon Solution 0.55 (0.25 F) MG/0.6ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.55 (0.25 F)","strength_unit_of_measure":"MG/0.6ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79309902900510","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride Combinations","drug_name":"Fluor-a-day Tablet Chewable 0.25 (F)-236.79 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25 (F)-236.79","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79309902900530","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride Combinations","drug_name":"Fluor-a-day Tablet Chewable 1 (F)-236.79 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1 (F)-236.79","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86806010222010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Diagnostic Products","drug_name":"Fluorescein-Benoxinate Solution 0.25-0.4 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25-0.4","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79300020002030","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Fluoritab Solution 0.275 (0.125 F) MG/DROP Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.275 (0.125 F)","strength_unit_of_measure":"MG/DROP","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79300020000510","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Fluoritab Tablet Chewable 1.1 (0.5 F) MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.1 (0.5 F)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86300020001810","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroids","drug_name":"Fluorometholone Suspension 0.1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79300020002035","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Flura-Drops Solution 0.55 (0.25 F) MG/DROP Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.55 (0.25 F)","strength_unit_of_measure":"MG/DROP","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86805020102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Nonsteroidal Anti-inflammatory Agents","drug_name":"Flurbiprofen Sodium Solution 0.03 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.03","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100012000315","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Flurbiprofen Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100012000310","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Flurbiprofen Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402440000110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiandrogens","drug_name":"Flutamide Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902758020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone Furoate-Vilanterol Aerosol Powder Breath Activated 100-25 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-25","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902758030","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone Furoate-Vilanterol Aerosol Powder Breath Activated 200-25 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-25","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550068103710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Fluticasone Propionate Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44400033208020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Fluticasone Propionate Diskus Aerosol Powder Breath Activated 100 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400033208030","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Fluticasone Propionate Diskus Aerosol Powder Breath Activated 250 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400033208010","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Fluticasone Propionate Diskus Aerosol Powder Breath Activated 50 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400033223230","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Fluticasone Propionate HFA Aerosol 110 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"24","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"110","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400033223240","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Fluticasone Propionate HFA Aerosol 220 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"24","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400033223220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Fluticasone Propionate HFA Aerosol 44 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21.20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"44","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550068104120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Fluticasone Propionate Lotion 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550068104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Fluticasone Propionate Ointment 0.005 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.005","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"42200032301810","therapeutic_category":"NASAL AGENTS - SYSTEMIC AND TOPICAL (Medications to treat nasal congestion and nasal allergies)","therapeutic_class":"Nasal Steroids","drug_name":"Fluticasone Propionate Suspension 50 MCG/ACT Nasal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"16","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/ACT","route":"Nasal","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902708020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone-Salmeterol Aerosol Powder Breath Activated 100-50 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-50","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902708015","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone-Salmeterol Aerosol Powder Breath Activated 113-14 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"113-14","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902708025","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone-Salmeterol Aerosol Powder Breath Activated 232-14 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"232-14","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902708030","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone-Salmeterol Aerosol Powder Breath Activated 250-50 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-50","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902708040","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone-Salmeterol Aerosol Powder Breath Activated 500-50 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-50","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902708010","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Fluticasone-Salmeterol Aerosol Powder Breath Activated 55-14 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"55-14","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400030100120","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Fluvastatin Sodium Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400030100140","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Fluvastatin Sodium Capsule 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17100020401800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluvirin Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002040E605","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluvirin Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002023E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluzone High-Dose Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100020251800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluzone Quadrivalent Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002025D310","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluzone Quadrivalent Suspension Pen-Injector 9 MCG/STRAIN Intradermal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9","strength_unit_of_measure":"MCG/STRAIN","route":"Intradermal","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002025E610","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluzone Quadrivalent Suspension Prefilled Syringe 0.25 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710002025E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Fluzone Quadrivalent Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82200010000315","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Folic Acid/Folates","drug_name":"Folic Acid Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"82200010000305","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Folic Acid/Folates","drug_name":"Folic Acid Tablet 400 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"83103030102045","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Synthetic Heparinoid-Like Agents","drug_name":"Fondaparinux Sodium Solution 10 MG/0.8ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83103030102020","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Synthetic Heparinoid-Like Agents","drug_name":"Fondaparinux Sodium Solution 2.5 MG/0.5ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83103030102035","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Synthetic Heparinoid-Like Agents","drug_name":"Fondaparinux Sodium Solution 5 MG/0.4ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83103030102040","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Synthetic Heparinoid-Like Agents","drug_name":"Fondaparinux Sodium Solution 7.5 MG/0.6ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG/0.6ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"92000005002010","therapeutic_category":"ANTISEPTICS & DISINFECTANTS (Agents to clean and disinfect the skin)","therapeutic_class":"Antiseptics & Disinfectants","drug_name":"Formaldehyde Solution 10 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44201027102520","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Formoterol Fumarate Nebulization Solution 20 MCG/2ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MCG/2ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12104525100330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Fosamprenavir Calcium Tablet 700 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"700","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100027100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Fosinopril Sodium Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100027100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Fosinopril Sodium Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100027100340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Fosinopril Sodium Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802400310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Fosinopril Sodium-HCTZ Tablet 10-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802400320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Fosinopril Sodium-HCTZ Tablet 20-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21533076250120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Fotivda Capsule 0.89 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.89","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21533076250130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Fotivda Capsule 1.34 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.34","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"83101010102015","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin SOLUTION 10000 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10000","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101010102053","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin SOLUTION 12500 UNIT/0.5ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12500","strength_unit_of_measure":"UNIT/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101010102056","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin SOLUTION 15000 UNIT/0.6ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15000","strength_unit_of_measure":"UNIT/0.6ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101010102060","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin SOLUTION 18000 UNT/0.72ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18000","strength_unit_of_measure":"UNT/0.72ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101010102020","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin SOLUTION 2500 UNIT/0.2ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2500","strength_unit_of_measure":"UNIT/0.2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83101010102040","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin SOLUTION 5000 UNIT/0.2ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5000","strength_unit_of_measure":"UNIT/0.2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310101010E530","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin Solution Prefilled Syringe 10000 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10000","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310101010E535","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin Solution Prefilled Syringe 12500 UNIT/0.5ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12500","strength_unit_of_measure":"UNIT/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310101010E540","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin Solution Prefilled Syringe 15000 UNIT/0.6ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15000","strength_unit_of_measure":"UNIT/0.6ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310101010E550","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin Solution Prefilled Syringe 18000 UNT/0.72ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18000","strength_unit_of_measure":"UNT/0.72ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310101010E505","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin Solution Prefilled Syringe 2500 UNIT/0.2ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2500","strength_unit_of_measure":"UNIT/0.2ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8310101010E515","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Low Molecular Weight Heparins","drug_name":"Fragmin Solution Prefilled Syringe 5000 UNIT/0.2ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5000","strength_unit_of_measure":"UNIT/0.2ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202007100900","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Control Solution Liquid In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202010006400","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Flash System Kit","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202010006410","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Freedom Lite Kit w/Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"w/Device","strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94100030006100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Diagnostic Tests","drug_name":"FreeStyle InsuLinx Test Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202025006300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Lancets","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97202012026200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 14 Day Reader Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 14 Day Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 2 Plus Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012026200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 2 Reader Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 2 Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 3 Plus Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012026200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 3 Reader Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012046300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre 3 Sensor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202012026200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Libre Reader Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202010006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Lite Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202010006410","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Lite Kit w/Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"w/Device","strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94100030006100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Diagnostic Tests","drug_name":"FreeStyle Lite Test Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202010006410","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle Precision Neo System Kit w/Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"w/Device","strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94100030006100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Diagnostic Tests","drug_name":"FreeStyle Precision Neo Test Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97202010006400","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Glucose Monitoring Test Supplies","drug_name":"FreeStyle System Kit","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94100030006100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Diagnostic Tests","drug_name":"FreeStyle Test Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406030100320","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Frovatriptan Succinate Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000000515","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"Fruity Chews/Iron Tablet Chewable Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21335035000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Fruzaqla Capsule 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"84","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21335035000140","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Fruzaqla Capsule 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240157020E520","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Granulocyte Colony-Stimulating Factors (G-CSF)","drug_name":"Fulphila Solution Prefilled Syringe 6 MG/0.6ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG/0.6ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2140353000E530","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Estrogen Receptor Antagonist","drug_name":"Fulvestrant Solution Prefilled Syringe 250 MG/5ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Intramuscular","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"37200030002050","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Furosemide Solution 10 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37200030002045","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Furosemide SOLUTION 8 MG/ML ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37200030000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Furosemide Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37200030000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Furosemide Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37200030000315","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Loop Diuretics","drug_name":"Furosemide Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72550060001820","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"AMPA Glutamate Receptor Antagonists","drug_name":"Fycompa Suspension 0.5 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"680","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72550060000350","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"AMPA Glutamate Receptor Antagonists","drug_name":"Fycompa Tablet 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72550060000360","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"AMPA Glutamate Receptor Antagonists","drug_name":"Fycompa Tablet 12 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72550060000310","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"AMPA Glutamate Receptor Antagonists","drug_name":"Fycompa Tablet 2 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72550060000320","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"AMPA Glutamate Receptor Antagonists","drug_name":"Fycompa Tablet 4 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72550060000330","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"AMPA Glutamate Receptor Antagonists","drug_name":"Fycompa Tablet 6 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72550060000340","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"AMPA Glutamate Receptor Antagonists","drug_name":"Fycompa Tablet 8 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600030000110","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Gabapentin Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600030000130","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Gabapentin Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600030000140","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Gabapentin Capsule 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600030002020","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Gabapentin Solution 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600030000330","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Gabapentin Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600030000340","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Gabapentin Tablet 800 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"30903650100120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Fabry Disease - Agents","drug_name":"Galafold Capsule 123 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"14","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"123","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051030107030","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 16 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"16","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051030107040","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 24 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"24","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051030107020","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Galantamine Hydrobromide ER Capsule Extended Release 24 Hour 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051030102020","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Galantamine Hydrobromide Solution 4 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051030100340","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Galantamine Hydrobromide Tablet 12 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051030100320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Galantamine Hydrobromide Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051030100330","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Galantamine Hydrobromide Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100065501800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Gardasil 9 Suspension 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710006550E600","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Gardasil 9 Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100065101820","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Gardasil Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas Relief Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas Relief Extra Strength Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas Relief Extra Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas Relief Maximum Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000510","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas Relief Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas Relief Ultra Strength Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas-X Extra Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Gas-X Ultra Strength Capsule 180 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101029002030","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Gatifloxacin Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52533070006420","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Glucagon-Like Peptide-2 (GLP-2) Analogs","drug_name":"Gattex KIT 5 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46992005302140","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bowel Evacuant Combinations","drug_name":"GaviLyte-C Solution Reconstituted 240 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46992005302130","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bowel Evacuant Combinations","drug_name":"GaviLyte-G Solution Reconstituted 236 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"236","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46992004302120","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bowel Evacuant Combinations","drug_name":"GaviLyte-N with Flavor Pack Solution Reconstituted 420 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"420","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21535750000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - RET Inhibitors","drug_name":"Gavreto Capsule 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21360030000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Gefitinib Tablet 250 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"39200030000310","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Fibric Acid Derivatives","drug_name":"Gemfibrozil Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"52400020002010","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Intestinal Acidifiers","drug_name":"Generlac Solution 10 GM/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM/15ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E188","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin Cartridge 12 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E159","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin Cartridge 5 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E404","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 0.2 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E407","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 0.4 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E413","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 0.8 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.8","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E416","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 1 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E419","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 1.2 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.2","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E422","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 1.4 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.4","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E425","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 1.6 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.6","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E428","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 1.8 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.8","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E431","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Genotropin MiniQuick Prefilled Syringe 2 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100050103705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"Gentamicin Sulfate Cream 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100050104205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"Gentamicin Sulfate Ointment 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101030004205","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Gentamicin Sulfate Ointment 0.3 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Ointment","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101030002005","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Gentamicin Sulfate Solution 0.3 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010005205","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Gentle Laxative Suppository 10 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Gentle Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109904290315","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Genvoya Tablet 150-150-200-10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150-150-200-10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Geri-kot Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002150316","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Gianvi Tablet 3-0.02 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3-0.02","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Gildess FE 1.5/30 Tablet 1.5-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21360006100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Gilotrif Tablet 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GILOTRIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21360006100330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Gilotrif Tablet 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GILOTRIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21360006100340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Gilotrif Tablet 40 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GILOTRIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240003010E520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents","drug_name":"Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240003010E540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents","drug_name":"Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240003010E520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents","drug_name":"Glatopa Solution Prefilled Syringe 20 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240003010E540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents","drug_name":"Glatopa Solution Prefilled Syringe 40 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"12","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21102020000110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrosoureas","drug_name":"Gleostine Capsule 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21102020000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrosoureas","drug_name":"Gleostine Capsule 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21102020000115","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrosoureas","drug_name":"Gleostine Capsule 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27200027000310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"Glimepiride Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200027000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"Glimepiride Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200027000340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"Glimepiride Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030007520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE ER Tablet Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030007505","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE ER Tablet Extended Release 24 Hour 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030007510","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE ER Tablet Extended Release 24 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030000310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030000305","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030007520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE XL Tablet Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030007505","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE XL Tablet Extended Release 24 Hour 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200030007510","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glipiZIDE XL Tablet Extended Release 24 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27997002350320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylurea-Biguanide Combinations","drug_name":"glipiZIDE-metFORMIN HCl Tablet 2.5-250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27997002350325","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylurea-Biguanide Combinations","drug_name":"glipiZIDE-metFORMIN HCl Tablet 2.5-500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27997002350340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylurea-Biguanide Combinations","drug_name":"glipiZIDE-metFORMIN HCl Tablet 5-500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Global Alcohol Prep Ease Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Global Ease Inject Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Global Ease Inject Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Global Ease Inject Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Global Ease Inject Pen Needles 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27300010202105","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"GlucaGen HypoKit Solution Reconstituted 1 MG Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300010106410","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Glucagon Emergency Kit 1 MG Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300010002105","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Glucagon Emergency Solution Reconstituted 1 MG Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Glucerna 1.0 Cal Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Glucerna Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27300030004020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Gluco Burst Gel 40 % Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"%","route":"Oral","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030004020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Glucose Gel 40 % Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"%","route":"Oral","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030000515","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Glucose Tablet Chewable 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27309902400520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other - Combinations","drug_name":"Glucose Tablet Chewable 4-6 GM-MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4-6","strength_unit_of_measure":"GM-MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78310000000100","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Multiple Vitamins w/ Minerals","drug_name":"Glucoten Capsule Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200040100310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glyBURIDE Micronized Tablet 1.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200040100320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glyBURIDE Micronized Tablet 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200040100340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glyBURIDE Micronized Tablet 6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200040000305","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glyBURIDE Tablet 1.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200040000310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glyBURIDE Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27200040000315","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylureas","drug_name":"glyBURIDE Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27997002400310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylurea-Biguanide Combinations","drug_name":"GlyBURIDE-MetFORMIN Tablet 1.25-250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25-250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27997002400320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylurea-Biguanide Combinations","drug_name":"GlyBURIDE-MetFORMIN Tablet 2.5-500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27997002400330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sulfonylurea-Biguanide Combinations","drug_name":"glyBURIDE-metFORMIN Tablet 5-500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46600010005206","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"Glycerin (Infants & Children) Suppository 1 GM Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"GNP 8 Hour Pain Reliever Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"GNP Adult Aspirin Low Strength Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"GNP Alcohol Swabs Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"48991002050560","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"GNP Antacid & Anti-Gas Tablet Chewable 1000-60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000-60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002150520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"GNP Antacid Extra Strength Tablet Chewable 160-105 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160-105","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"GNP Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"GNP Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002300541","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"GNP Antacid Tablet Chewable 550-110 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"550-110","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"GNP Antacid Ultra Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"GNP Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"GNP Anti-Gas Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"GNP Aspirin Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"GNP Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"GNP Aspirin Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"GNP Aspirin Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"GNP Bacitracin Zinc Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640344","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"GNP Calcium 500 +D3 Tablet 500-15 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-15","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640357","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"GNP Calcium 600 +D3 Tablet 600-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"GNP Calcium Tablet 1500 (600 Ca) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1500 (600 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"GNP Calcium Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000000515","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"GNP Childrens Chewables/Iron Tablet Chewable 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010007210","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"GNP Childrens Easy-Melts Tablet Dispersible 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"GNP Childrens Ibuprofen Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"GNP Clickfine Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"GNP Clickfine Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"55104020003710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"GNP Clotrimazole 3 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"GNP Enema Enema 7-19 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7-19","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002151809","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"GNP Foaming Antacid Suspension 95-358 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"95-358","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002200505","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"GNP Foaming Antacid Tablet Chewable 80-20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"GNP Gas Relief Extra Strength Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"GNP Gas Relief Extra Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"GNP Gas Relief Max St Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030000515","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"GNP Glucose Tablet Chewable 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075003715","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"GNP Hydrocortisone Cream 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"GNP Hydrocortisone Max St Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"GNP Ibuprofen Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"GNP Ibuprofen Infants Suspension 50 MG/1.25ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/1.25ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90971501406320","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Skin Cleansers","drug_name":"GNP Isopropyl Alcohol Wipes 70 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":"External","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270040006510","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"GNP Lansoprazole Capsule Delayed Release 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90900035000910","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"GNP Lice Treatment Liquid 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"GNP Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48400020000305","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Magnesium Salts","drug_name":"GNP Magnesium Oxide Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106410","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"GNP Miconazole 3 Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"GNP Miconazole 7 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"GNP Motion Sickness Relief Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"GNP Motion Sickness Relief Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100127","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"GNP Naproxen Sodium Capsule 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"GNP Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002820","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"GNP Nicotine Polacrilex Gum 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"GNP Nicotine Polacrilex Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"GNP Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"GNP Pain Relief Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"GNP Pain Relief Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000307","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"GNP Pink Bismuth Tablet 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"GNP Pink Bismuth Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030000515","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"GNP Quick Dissolve Glucose Tablet Chewable 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"GNP Sleep Aid Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533550000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Gomekli Capsule 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"168","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533550000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Gomekli Capsule 2 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"84","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533550007320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Gomekli Tablet Soluble 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"168","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"GoodSense Aspirin Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"GoodSense Gas Relief Extra St Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"GoodSense Gas Relief Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"GoodSense Nicotine Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"GoodSense Senna Laxative Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50250035100310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"5-HT3 Receptor Antagonists","drug_name":"Granisetron HCl Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000030101805","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Griseofulvin Microsize Suspension 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000030100315","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Griseofulvin Microsize Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000030200305","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Griseofulvin Ultramicrosize Tablet 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000030200315","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Griseofulvin Ultramicrosize Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36201025100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"guanFACINE HCl Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201025100330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"guanFACINE HCl Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78420000000501","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals","drug_name":"Gummi Bear Multivitamin/Min Tablet Chewable Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2730001000D520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Gvoke HypoPen 2-Pack Solution Auto-Injector 0.5 MG/0.1ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG/0.1ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2730001000D530","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Gvoke HypoPen 2-Pack Solution Auto-Injector 1 MG/0.2ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/0.2ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300010002020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Gvoke Kit Solution 1 MG/0.2ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.40","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/0.2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2730001000E520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Gvoke PFS Solution Prefilled Syringe 0.5 MG/0.1ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG/0.1ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2730001000E530","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Gvoke PFS Solution Prefilled Syringe 1 MG/0.2ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.40","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/0.2ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001520D510","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Hadlima PushTouch Solution Auto-Injector 40 MG/0.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.80","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001520D520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Hadlima PushTouch Solution Auto-Injector 40 MG/0.8ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.60","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001520E510","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Hadlima Solution Prefilled Syringe 40 MG/0.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.80","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6627001520E520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Anti-TNF-alpha - Monoclonal Antibodies","drug_name":"Hadlima Solution Prefilled Syringe 40 MG/0.8ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.60","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85802022002130","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"C1 Esterase Inhibitors","drug_name":"Haegarda SOLUTION RECONSTITUTED 2000 UNIT Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2000","strength_unit_of_measure":"UNIT","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85802022002140","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"C1 Esterase Inhibitors","drug_name":"Haegarda SOLUTION RECONSTITUTED 3000 UNIT Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3000","strength_unit_of_measure":"UNIT","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610312","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Hailey 24 Fe Tablet 1-20 MG-MCG(24) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG(24)","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550073103710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Halobetasol Propionate Cream 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550073104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Halobetasol Propionate Ointment 0.05 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.05","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100008001840","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Havrix Suspension 1440 EL U/ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1440","strength_unit_of_measure":"EL U/ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100008001830","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Havrix Suspension 720 EL U/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"720","strength_unit_of_measure":"EL U/0.5ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710000800E680","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Havrix Suspension Prefilled Syringe 1440 EL U/ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1440","strength_unit_of_measure":"EL U/ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710000800E660","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Havrix Suspension Prefilled Syringe 720 EL U/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"720","strength_unit_of_measure":"EL U/0.5ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40100025100120","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Peripheral Vasodilators","drug_name":"HDL Benefit Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"HealthWise Short Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"HealthyLax Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002150520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"Heartburn Antacid Ex St Tablet Chewable 160-105 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160-105","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Heather Tablet 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"H-E-B inControl Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"H-E-B inControl Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"H-E-B inControl Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"H-E-B inControl Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"H-E-B inControl Pen Needles 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040102080","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Hemangeol SOLUTION 4.28 MG/ML ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 1 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4.28","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512087006335","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"HemeNatal OB + DHA 28-6-1 & 203 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-6-1 & 203","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512090000335","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"HemeNatal OB Tablet 28-6-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-6-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"83100020302030","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Heparin Lock Flush Solution 100 UNIT/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020302021","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Heparin Na (Pork) Lock Flsh PF Solution 10 UNIT/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"UNIT/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020302031","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Heparin Na (Pork) Lock Flsh PF Solution 100 UNIT/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020302020","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Heparin Sod (Pork) Lock Flush Solution 10 UNIT/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"UNIT/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020302030","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Heparin Sod (Pork) Lock Flush Solution 100 UNIT/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020356410","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Heparin Sodium Flush KIT 10-0.9 UNIT/ML-% Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-0.9","strength_unit_of_measure":"UNIT/ML-%","route":"Intravenous","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020356420","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Heparin Sodium Flush Kit 100-0.9 UNIT/ML-% Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-0.9","strength_unit_of_measure":"UNIT/ML-%","route":"Intravenous","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100010302020","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Heplisav-B Solution 20 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21170092000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Anti-HER2 Agents","drug_name":"Hernexeos Tablet 60 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21100005000110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Alkylating Agents","drug_name":"Hexalen Capsule 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200030102122","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Hiberix Solution Reconstituted 10 MCG Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"High Potency Calcium Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202050","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Hizentra Solution 1 GM/5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM/5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202065","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Hizentra Solution 10 GM/50ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM/50ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202054","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Hizentra Solution 2 GM/10ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM/10ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"19100020202058","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Hizentra Solution 4 GM/20ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM/20ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1910002020E565","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Hizentra Solution Prefilled Syringe 10 GM/50ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM/50ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1910002020E540","therapeutic_category":"PASSIVE IMMUNIZING AND TREATMENT AGENTS(Medications to support the immune system or prevent infection)","therapeutic_class":"Immune Serums","drug_name":"Hizentra Solution Prefilled Syringe 4 GM/20ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM/20ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"HM Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"HM Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"HM Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"HM Aspirin Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"HM Bacitracin OINTMENT 500 UNIT/GM EXTERNAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"HM Calcium Antacid Ex St Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"HM Calcium Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"HM Enema Enema 7-19 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7-19","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"HM Gas Relief Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100105","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"HM Loperamide HCl Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"HM Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48400020000305","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Magnesium Salts","drug_name":"HM Magnesium Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"HM Motion Relief Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"HM Motion Sickness Relief Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"HM Nicotine Patch 24 Hour 14 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"HM Nicotine Patch 24 Hour 21 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"HM Nicotine Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"HM Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"HM Nicotine Polacrilex Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"HM Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512018006325","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"HM One Daily Prenatal 28-0.8 & 440 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.8 & 440","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"HM Pain Relief Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"HM Pain Reliever Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"HM Rapid Melts Junior Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"HM Sleep Aid Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86350030102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Cycloplegic Mydriatics","drug_name":"Homatropine HBr Solution 5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000000500","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"Honey Bears w/Iron-Zinc Tablet Chewable 30-200-3 Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30-200-3","strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400500D221","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG Junior KwikPen Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400500D222","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG KwikPen Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710408000D340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG Mix 50/50 KwikPen Suspension Pen-injector (50-50) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(50-50) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104080001840","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG Mix 50/50 Suspension (50-50) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(50-50) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710408000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG Mix 75/25 KwikPen Suspension Pen-injector (75-25) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(75-25) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104080001820","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG Mix 75/25 Suspension (75-25) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(75-25) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104005002022","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400500E220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumaLOG Solution Cartridge 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"3010002000E130","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Humatrope Cartridge 12 MG Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E140","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Humatrope Cartridge 24 MG Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"24","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010002000E120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Humatrope Cartridge 6 MG Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002132","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Humatrope SOLUTION RECONSTITUTED 12 MG INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002150","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Humatrope SOLUTION RECONSTITUTED 24 MG INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"24","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Humatrope Solution Reconstituted 5 MG Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002125","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Humatrope SOLUTION RECONSTITUTED 6 MG INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27104010002015","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumuLIN R U-500 (CONCENTRATED) Solution 500 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710401000D250","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"HumuLIN R U-500 KwikPen Solution Pen-injector 500 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36400010100305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Vasodilators","drug_name":"hydrALAZINE HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36400010100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Vasodilators","drug_name":"hydrALAZINE HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36400010100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Vasodilators","drug_name":"hydrALAZINE HCl Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36400010100315","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Vasodilators","drug_name":"hydrALAZINE HCl Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600040000110","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"hydroCHLOROthiazide Capsule 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600040000303","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"hydroCHLOROthiazide Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600040000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"hydroCHLOROthiazide Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600040000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"hydroCHLOROthiazide Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"65991702102015","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Solution 2.5-108 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-108","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702102015","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Solution 5-217 MG/10ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-217","strength_unit_of_measure":"MG/10ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702102015","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Solution 7.5-325 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5-325","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702100375","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Tablet 10-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702100305","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Tablet 10-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702100302","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Tablet 2.5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702100309","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Tablet 5-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702100356","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Tablet 5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702100322","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Tablet 7.5-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702100358","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Acetaminophen Tablet 7.5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702500330","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Ibuprofen Tablet 10-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702500315","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"HYDROcodone-Ibuprofen Tablet 5-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65991702500320","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Hydrocodone Combinations","drug_name":"Hydrocodone-Ibuprofen Tablet 7.5-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"89100010003720","therapeutic_category":"ANORECTAL AND RELATED PRODUCTS(Medications to treat pain and inflammation in the anus or rectum)","therapeutic_class":"Rectal Steroids","drug_name":"Hydrocortisone (Perianal) Cream 2.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075323705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Butyr Lipo Base Cream 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075303705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Butyrate Cream 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075304205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Butyrate Ointment 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075302020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Butyrate Solution 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075003715","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Cream 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550075003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550075003725","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Cream 2.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"89150010005110","therapeutic_category":"ANORECTAL AND RELATED PRODUCTS(Medications to treat pain and inflammation in the anus or rectum)","therapeutic_class":"Intrarectal Steroids","drug_name":"Hydrocortisone Enema 100 MG/60ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/60ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Lotion 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Lotion 2.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Ointment 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004215","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Ointment 2.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025000305","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Hydrocortisone Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025000310","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Hydrocortisone Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025000303","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Hydrocortisone Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075203705","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Valerate Cream 0.2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075204205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Hydrocortisone Valerate Ointment 0.2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87300020102000","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Steroids","drug_name":"Hydrocortisone-Acetic Acid Solution 1-2 % Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-2","strength_unit_of_measure":"%","route":"Otic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100035107531","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl ER Tablet Extended Release 24 Hour 12 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100035107541","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl ER Tablet Extended Release 24 Hour 16 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"16","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100035107556","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl ER Tablet Extended Release 24 Hour 32 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100035107521","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl ER Tablet Extended Release 24 Hour 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100035100920","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl Liquid 1 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100035100310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100035100320","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100035100330","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"HYDROmorphone HCl Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"82100020002010","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Cobalamins","drug_name":"Hydroxocobalamin SOLUTION 1000 MCG/ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MCG/ML","route":"Intramuscular","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13000020100305","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarials","drug_name":"Hydroxychloroquine Sulfate Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21700030000105","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastics Misc.","drug_name":"Hydroxyurea Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Endari","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"57200040101210","therapeutic_category":"ANTIANXIETY AGENTS (Medications to treat anxiety disorders)","therapeutic_class":"Antianxiety Agents - Misc.","drug_name":"hydrOXYzine HCl Syrup 10 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"57200040100305","therapeutic_category":"ANTIANXIETY AGENTS (Medications to treat anxiety disorders)","therapeutic_class":"Antianxiety Agents - Misc.","drug_name":"hydrOXYzine HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"57200040100310","therapeutic_category":"ANTIANXIETY AGENTS (Medications to treat anxiety disorders)","therapeutic_class":"Antianxiety Agents - Misc.","drug_name":"hydrOXYzine HCl Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"57200040100315","therapeutic_category":"ANTIANXIETY AGENTS (Medications to treat anxiety disorders)","therapeutic_class":"Antianxiety Agents - Misc.","drug_name":"hydrOXYzine HCl Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"57200040200115","therapeutic_category":"ANTIANXIETY AGENTS (Medications to treat anxiety disorders)","therapeutic_class":"Antianxiety Agents - Misc.","drug_name":"hydrOXYzine Pamoate Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"57200040200105","therapeutic_category":"ANTIANXIETY AGENTS (Medications to treat anxiety disorders)","therapeutic_class":"Antianxiety Agents - Misc.","drug_name":"hydrOXYzine Pamoate Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"57200040200110","therapeutic_category":"ANTIANXIETY AGENTS (Medications to treat anxiety disorders)","therapeutic_class":"Antianxiety Agents - Misc.","drug_name":"hydrOXYzine Pamoate Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90784070004020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Macrolide Immunosuppressants - Topical","drug_name":"Hyftor Gel 0.2 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8510505020D520","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Antihemophilic Products - Monoclonal Antibodies","drug_name":"Hympavzi Solution Auto-Injector 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051020186320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Hypodermic Needle 18G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Hypodermic Needle 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Hy-Vee All Day Relief Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27309902400520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other - Combinations","drug_name":"Hy-Vee Glucose Tablet Chewable 4-6 GM-MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4-6","strength_unit_of_measure":"GM-MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30042048100360","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Bisphosphonates","drug_name":"Ibandronate Sodium Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531060000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Ibrance CAPSULE 100 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Ibrance (palbociclib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531060000140","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Ibrance CAPSULE 125 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Ibrance (palbociclib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531060000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Ibrance CAPSULE 75 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Ibrance (palbociclib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531060000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Ibrance Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531060000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Ibrance Tablet 125 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531060000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Ibrance Tablet 75 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533875050130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Tropomyosin Receptor Kinase Inhibitors","drug_name":"Ibtrozi Capsule 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000330","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"IBU Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000340","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"IBU TABLET 800 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"800","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Childrens Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Childrens Suspension 200 MG/10ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/10ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Junior Strength Tablet Chewable 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000305","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000330","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000340","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ibuprofen Tablet 800 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85820040102020","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Bradykinin B2 Receptor Antagonists","drug_name":"Icatibant Acetate Solution 30 MG/3ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8582004010E520","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Bradykinin B2 Receptor Antagonists","drug_name":"Icatibant Acetate Solution Prefilled Syringe 30 MG/3ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531875100315","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Iclusig Tablet 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531875100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Iclusig Tablet 15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531875100330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Iclusig Tablet 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531875100340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Iclusig Tablet 45 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39500035100110","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Antihyperlipidemics - Misc.","drug_name":"Icosapent Ethyl Capsule 0.5 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39500035100120","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Antihyperlipidemics - Misc.","drug_name":"Icosapent Ethyl Capsule 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21535030200340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Isocitrate Dehydrogenase-2 (IDH2) Inhibitors","drug_name":"IDHIFA Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21535030200320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Isocitrate Dehydrogenase-2 (IDH2) Inhibitors","drug_name":"IDHIFA Tablet 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66460020002015","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Interleukin-1beta Blockers","drug_name":"Ilaris SOLUTION 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025058010E520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Ilumya Solution Prefilled Syringe 100 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531835100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Imatinib Mesylate Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531835100340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Imatinib Mesylate Tablet 400 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532133000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Imbruvica Capsule 140 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"140","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532133000110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Imbruvica Capsule 70 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532133001820","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Imbruvica Suspension 70 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532133000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Imbruvica Tablet 140 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"IMBRUVICA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"140","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532133000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Imbruvica Tablet 280 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"IMBRUVICA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"280","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532133000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Imbruvica Tablet 420 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"IMBRUVICA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"420","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16159902402110","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Carbapenem Combinations","drug_name":"Imipenem-Cilastatin Solution Reconstituted 250 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16159902402120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Carbapenem Combinations","drug_name":"Imipenem-Cilastatin Solution Reconstituted 500 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90773040003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Immunomodulators Imidazoquinolinamines - Topical","drug_name":"Imiquimod Cream 5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16000036000120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Anti-infective Agents - Misc.","drug_name":"Impavido CAPSULE 50 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"84","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30160045002020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Insulin-Like Growth Factors (Somatomedins)","drug_name":"Increlex Solution 40 MG/4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"INCRELEX"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/4ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"37600050000303","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"Indapamide Tablet 1.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600050000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"Indapamide Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"66100030000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Indomethacin Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100030000110","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Indomethacin Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100030000205","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Indomethacin ER Capsule Extended Release 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990003201840","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Infanrix Suspension 25-58-10 Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25-58-10","strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Infants Gas Relief Suspension 20 MG/0.3ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/0.3ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Infants Gas Relief Suspension 40 MG/0.6ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.6ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Infants Ibuprofen Suspension 50 MG/1.25ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/1.25ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Infants Pain & Fever Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380080200120","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Ingrezza Capsule 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380080200130","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Ingrezza Capsule 60 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380080200140","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Ingrezza CAPSULE 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380080206830","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Ingrezza Capsule Sprinkle 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380080206850","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Ingrezza Capsule Sprinkle 60 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62380080206870","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Ingrezza Capsule Sprinkle 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Sprinkle","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6238008020B220","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Movement Disorder Drug Therapy","drug_name":"Ingrezza Capsule Therapy Pack 40 & 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40 & 80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21403536700320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Estrogen Receptor Antagonist","drug_name":"Inluriyo Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21335013000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Inlyta Tablet 1 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"INLYTA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21335013000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Inlyta Tablet 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"INLYTA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21990002250320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic Combinations","drug_name":"Inqovi Tablet 35-100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"35-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21537520200120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Inrebic Capsule 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"Inspirease","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075003715","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Instacort 5 Cream 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27300030004070","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Insta-Glucose Gel 77.4 % Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"77.4","strength_unit_of_measure":"%","route":"Oral","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2710407000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Asp Prot & Asp FlexPen Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400200D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Aspart FlexPen Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400200E220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Aspart PenFill Solution Cartridge 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104070001820","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Aspart Prot & Aspart Suspension (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104002002022","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Aspart Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104002002020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Aspart Solution 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400700D210","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Degludec FlexTouch Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400700D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Degludec FlexTouch Solution Pen-Injector 200 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104007002020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Degludec Solution 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400500D222","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Lispro (1 Unit Dial) Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400500D221","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Lispro Junior KwikPen Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710408000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Lispro Prot & Lispro Suspension Pen-Injector (75-25) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"(75-25) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104005002022","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Lispro Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104005002020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Insulin Lispro Solution 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Insupen Pen Needles 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12109035000310","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Intelence TABLET 25 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94101024356400","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Infection Tests","drug_name":"InteliSwab COVID-19 Rapid Test Kit In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Introvale Tablet 0.15-0.03 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-0.03","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104580200120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Invirase Capsule 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104580200320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Invirase Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002200350","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet TABLET 150-1000 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002200340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet TABLET 150-500 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002200330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet TABLET 50-1000 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002200320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet TABLET 50-500 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002207550","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet XR Tablet Extended Release 24 Hour 150-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002207540","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet XR Tablet Extended Release 24 Hour 150-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002207530","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet XR Tablet Extended Release 24 Hour 50-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002207520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Invokamet XR Tablet Extended Release 24 Hour 50-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27700020000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Invokana Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27700020000330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Invokana Tablet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100050002250","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Ipol Injectable Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Injection","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100050001800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Ipol Suspension Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Injection","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44100030102020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Bronchodilators - Anticholinergics","drug_name":"Ipratropium Bromide Solution 0.02 % Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.02","strength_unit_of_measure":"%","route":"Inhalation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44209902012015","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Ipratropium-Albuterol Solution 0.5-2.5 (3) MG/3ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"615","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5-2.5 (3)","strength_unit_of_measure":"MG/3ML","route":"Inhalation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"83334030002120","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Thrombin Inhibitors - Hirudin Type","drug_name":"Iprivask Solution Reconstituted 15 MG Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52780020000320","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Peroxisome Proliferator-Activated Receptor Agonists","drug_name":"Iqirvo Tablet 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36150030000320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Irbesartan Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150030000340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Irbesartan Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150030000310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Irbesartan Tablet 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002300320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Irbesartan-hydroCHLOROthiazide Tablet 150-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002300340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Irbesartan-Hydrochlorothiazide Tablet 300-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12103060100330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Integrase Inhibitors","drug_name":"Isentress HD TABLET 600 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12103060100320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Integrase Inhibitors","drug_name":"Isentress Tablet 400 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12103060100540","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Integrase Inhibitors","drug_name":"Isentress TABLET CHEWABLE 100 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12103060100510","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Integrase Inhibitors","drug_name":"Isentress TABLET CHEWABLE 25 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Isibloom Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000060002005","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Isoniazid SOLUTION 100 MG/ML INJECTION","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000060001210","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Isoniazid Syrup 50 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000060000305","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Isoniazid Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000060000310","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Isoniazid Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90971501406320","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Skin Cleansers","drug_name":"Isopropyl Alcohol Wipes 70 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":"External","dose_form":null,"multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40995002400320","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Nitrate & Vasodilator Combinations","drug_name":"Isosorb Dinitrate-hydrALAZINE Tablet 20-37.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-37.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100020000310","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Dinitrate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100020000315","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Dinitrate Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100020000320","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Dinitrate Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100020000305","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Dinitrate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100025007540","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100025007520","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100025007530","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Mononitrate ER Tablet Extended Release 24 Hour 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100025000310","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Mononitrate Tablet 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100025000320","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Isosorbide Mononitrate Tablet 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Isosource HN Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90050013000110","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"ISOtretinoin Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"ISOtretinoin Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000130","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"ISOtretinoin Capsule 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90050013000140","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"ISOtretinoin Capsule 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000015000110","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Isradipine Capsule 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000015000120","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Isradipine Capsule 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30022060600320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Cortisol Synthesis Inhibitors","drug_name":"Isturisa Tablet 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30022060600340","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Cortisol Synthesis Inhibitors","drug_name":"Isturisa Tablet 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30022060600330","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Cortisol Synthesis Inhibitors","drug_name":"Isturisa Tablet 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21538045000310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Phosphatidylinositol 3-Kinase (PI3K) Inhibitors","drug_name":"Itovebi Tablet 3 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21538045000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Phosphatidylinositol 3-Kinase (PI3K) Inhibitors","drug_name":"Itovebi Tablet 9 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407035000120","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Itraconazole Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"34","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407035002020","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Itraconazole Solution 10 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40700035100320","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Sinus Node Inhibitors","drug_name":"Ivabradine HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40700035100330","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Sinus Node Inhibitors","drug_name":"Ivabradine HCl Tablet 7.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000007000310","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Ivermectin Tablet 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21757220300320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Ornithine Decarboxylase (ODC) Inhibitors","drug_name":"Iwilfin Tablet 192 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"192","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100025101800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Ixiaro Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21537560200320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Jakafi TABLET 10 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"JAKAFI"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21537560200325","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Jakafi TABLET 15 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"JAKAFI"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21537560200330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Jakafi TABLET 20 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"JAKAFI"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21537560200335","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Jakafi TABLET 25 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"JAKAFI"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21537560200310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Jakafi TABLET 5 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"JAKAFI"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"27992502700340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Janumet Tablet 50-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502700320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Janumet Tablet 50-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502707540","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Janumet XR Tablet Extended Release 24 Hour 100-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502707530","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Janumet XR Tablet Extended Release 24 Hour 50-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502707520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Janumet XR Tablet Extended Release 24 Hour 50-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27550070100340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"Januvia Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27550070100320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"Januvia Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27550070100330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"Januvia Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27700050000310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Jardiance Tablet 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27700050000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Jardiance Tablet 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002150316","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Jasmiel Tablet 3-0.02 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3-0.02","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23100030800130","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Androgens","drug_name":"Jatenzo Capsule 158 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"158","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23100030800135","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Androgens","drug_name":"Jatenzo Capsule 198 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"198","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23100030800140","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Androgens","drug_name":"Jatenzo Capsule 237 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"237","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908565103020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Javygtor Packet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908565103040","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Javygtor Packet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908565100320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Javygtor Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532165000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Jaypirca Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532165000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BTK Inhibitors","drug_name":"Jaypirca Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Jencycla Tablet 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502400340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Jentadueto Tablet 2.5-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502400320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Jentadueto Tablet 2.5-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502400330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Jentadueto Tablet 2.5-850 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-850","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502407520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Jentadueto XR Tablet Extended Release 24 Hour 2.5-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27992502407530","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 Inhibitor-Biguanide Combinations","drug_name":"Jentadueto XR Tablet Extended Release 24 Hour 5-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82402520000310","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors","drug_name":"Jesduvroq Tablet 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"720","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82402520000315","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors","drug_name":"Jesduvroq Tablet 2 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"360","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82402520000320","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors","drug_name":"Jesduvroq Tablet 4 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82402520000325","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors","drug_name":"Jesduvroq Tablet 6 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82402520000330","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Hypoxia-inducible Factor Prolyl Hydroxylase Inhibitors","drug_name":"Jesduvroq Tablet 8 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Jevity 1 Cal Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"99391540600320","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Activated Phosphoinositide 3-kinase Delta Syndrome Agent","drug_name":"Joenja Tablet 70 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Jolessa Tablet 0.15-0.03 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-0.03","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Jolivette Tablet 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64175070000320","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics - Selective NaV1.8 Sodium Channel Inhibitors","drug_name":"Journavx Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"29","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Juleber TABLET 0.15-30 MG-MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902280320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Juluca TABLET 50-25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002600320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Junel 1.5/30 TABLET 1.5-30 MG-MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002600310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Junel 1/20 Tablet 1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Junel FE 1.5/30 Tablet 1.5-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Junel FE 1/20 Tablet 1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85840030002020","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Plasma Kallikrein Inhibitors","drug_name":"Kalbitor SOLUTION 10 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Kalbitor (ecallantide)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45302030003005","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"CFTR Potentiators","drug_name":"Kalydeco Packet 13.4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"13.4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45302030003010","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"CFTR Potentiators","drug_name":"Kalydeco Packet 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45302030003002","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"CFTR Potentiators","drug_name":"Kalydeco Packet 5.8 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45302030003020","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"CFTR Potentiators","drug_name":"Kalydeco PACKET 50 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Kalydeco (ivacaftor)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45302030003030","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"CFTR Potentiators","drug_name":"Kalydeco PACKET 75 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Kalydeco (ivacaftor)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45302030000320","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"CFTR Potentiators","drug_name":"Kalydeco Tablet 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Kalydeco (ivacaftor)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010001830","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Kaopectate Extra Strength Suspension 525 MG/15ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"525","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30354030000310","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Non-steroidal Mineralocorticoid Receptor Antagonists","drug_name":"Kerendia Tablet 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30354030000320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Non-steroidal Mineralocorticoid Receptor Antagonists","drug_name":"Kerendia Tablet 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30354030000330","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Non-steroidal Mineralocorticoid Receptor Antagonists","drug_name":"Kerendia Tablet 40 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240506500D520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Monoclonal Antibodies","drug_name":"Kesimpta Solution Auto-Injector 20 MG/0.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.40","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"KetoCal 3:1 Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"KetoCal 4:1 Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90154045003710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Imidazole-Related Antifungals - Topical","drug_name":"Ketoconazole Cream 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90154045003920","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Imidazole-Related Antifungals - Topical","drug_name":"Ketoconazole Foam 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Foam","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90154045004510","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Imidazole-Related Antifungals - Topical","drug_name":"Ketoconazole Shampoo 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Shampoo","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"11404040000310","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Imidazoles","drug_name":"Ketoconazole Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94109902406100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Multiple Urine Tests","drug_name":"Keto-Diastix Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100035000103","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ketoprofen Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100035000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ketoprofen Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100037102030","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ketorolac Tromethamine +RFID Solution 30 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86805035102015","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Nonsteroidal Anti-inflammatory Agents","drug_name":"Ketorolac Tromethamine Solution 0.4 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86805035102020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Nonsteroidal Anti-inflammatory Agents","drug_name":"Ketorolac Tromethamine Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100037102015","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ketorolac Tromethamine Solution 15 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100037102030","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ketorolac Tromethamine Solution 30 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100037102071","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ketorolac Tromethamine Solution 60 MG/2ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/2ML","route":"Intramuscular","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100037100320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Ketorolac Tromethamine Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94100005006100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Diagnostic Tests","drug_name":"Ketostix Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86802040102010","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antiallergic","drug_name":"Ketotifen Fumarate Solution 0.025 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.025","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86802040102011","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antiallergic","drug_name":"Ketotifen Fumarate Solution 0.035 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.035","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6650006000D520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Interleukin-6 Receptor Inhibitors","drug_name":"Kevzara Solution Auto-Injector 150 MG/1.14ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/1.14ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6650006000D530","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Interleukin-6 Receptor Inhibitors","drug_name":"Kevzara Solution Auto-Injector 200 MG/1.14ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/1.14ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6650006000E520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Interleukin-6 Receptor Inhibitors","drug_name":"Kevzara Solution Prefilled Syringe 150 MG/1.14ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/1.14ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6650006000E530","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Interleukin-6 Receptor Inhibitors","drug_name":"Kevzara Solution Prefilled Syringe 200 MG/1.14ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/1.14ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6626001000E520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Interleukin-1 Receptor Antagonist (IL-1Ra)","drug_name":"Kineret Solution Prefilled Syringe 100 MG/0.67ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"KINERET"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18.76","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/0.67ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990004351820","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Kinrix Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1899000435E620","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Kinrix Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27104002022020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Kirsty Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2710400202D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Kirsty Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153107050B720","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Kisqali (200 MG Dose) Tablet Therapy Pack 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153107050B740","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Kisqali (400 MG Dose) Tablet Therapy Pack 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"42","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153107050B760","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Cyclin-Dependent Kinases (CDK) Inhibitors","drug_name":"Kisqali (600 MG Dose) Tablet Therapy Pack 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"63","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2199000260B730","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic Combinations","drug_name":"Kisqali Femara (200 MG Dose) Tablet Therapy Pack 200 & 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"49","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200 & 2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2199000260B740","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic Combinations","drug_name":"Kisqali Femara (400 MG Dose) Tablet Therapy Pack 200 & 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"70","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200 & 2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2199000260B760","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic Combinations","drug_name":"Kisqali Femara (600 MG Dose) Tablet Therapy Pack 200 & 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"91","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200 & 2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79700030000430","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Klor-Con 10 Tablet Extended Release 10 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030100430","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Klor-Con M10 Tablet Extended Release 10 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030100435","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Klor-Con M15 Tablet Extended Release 15 MEQ Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000420","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Klor-Con Tablet Extended Release 8 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"O","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"93400020100930","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Kloxxado Liquid 8 MG/0.1ML Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG/0.1ML","route":"Nasal","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49200020100303","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"KLS Acid Reducer Tablet 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"KLS Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"KLS Aspirin Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270040006510","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"KLS Lansoprazole Capsule Delayed Release 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"KLS Quit2 Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"KLS Rapid Release Pain Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533565500110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Koselugo Capsule 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533565500125","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Koselugo Capsule 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"KP Aspirin Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"KP Bisacodyl Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640160","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"KP Calcium 600+D Capsule 600-12.5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-12.5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"KP Calcium 600+D Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010000332","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"KP Ferrous Sulfate Tablet 325 (65 Fe) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325 (65 Fe)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82200010000310","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Folic Acid/Folates","drug_name":"KP Folic Acid Tablet 800 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"KP Hydrocortisone Max St Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270060106520","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"KP Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20.6 (20 Base)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512000000303","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"KPN Prenatal Tablet 0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21532410000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - KRAS Inhibitors","drug_name":"Krazati Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Kroger Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Kroger Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Kroger Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000430","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"K-Tab Tablet Extended Release 10 MEQ Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"O","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000445","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"K-Tab Tablet Extended Release 20 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"O","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000420","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"K-Tab Tablet Extended Release 8 MEQ Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Kurvelo Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25200050005313","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - IUD","drug_name":"Kyleena INTRAUTERINE DEVICE 19.5 MG INTRAUTERINE","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"19.5","strength_unit_of_measure":"MG","route":"Intrauterine","dose_form":"Intrauterine Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33300010100305","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Alpha-Beta Blockers","drug_name":"Labetalol HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33300010100310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Alpha-Beta Blockers","drug_name":"Labetalol HCl Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33300010100315","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Alpha-Beta Blockers","drug_name":"Labetalol HCl Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600036002060","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Lacosamide Solution 10 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600036000330","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Lacosamide Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600036000340","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Lacosamide Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600036000350","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Lacosamide Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600036000320","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Lacosamide Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"99750015002000","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Irrigation Solutions","drug_name":"Lactated Ringers Solution Irrigation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Irrigation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52400020002010","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Intestinal Acidifiers","drug_name":"Lactulose Encephalopathy Solution 10 GM/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM/15ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46600020002010","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"Lactulose Solution 10 GM/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM/15ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12700046000120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Misc. Antivirals","drug_name":"Lagevrio Capsule 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12106060002020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Pyrimidines","drug_name":"lamiVUDine Solution 10 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12352050000315","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis B Agents","drug_name":"lamiVUDine Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12106060000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Pyrimidines","drug_name":"lamiVUDine Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12106060000330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Pyrimidines","drug_name":"LamiVUDine Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902500320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"lamiVUDine-Zidovudine Tablet 150-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000000515","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"Land Before Time Multivitamin Tablet Chewable 15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270040006520","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Lansoprazole Capsule Delayed Release 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"4927004000H315","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Lansoprazole Tablet Delayed Release Dispersible 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 6 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release Dispersible","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"4927004000H330","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Lansoprazole Tablet Delayed Release Dispersible 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 6 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release Dispersible","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400300D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Lantus SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104003002020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Lantus Solution 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002600320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Larin 1.5/30 TABLET 1.5-30 MG-MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Larin Fe 1.5/30 Tablet 1.5-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86330050002020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Prostaglandins - Ophthalmic","drug_name":"Latanoprost Solution 0.005 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.005","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21360048300340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Lazcluze Tablet 240 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21360048300320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - EGFR Inhibitors","drug_name":"Lazcluze Tablet 80 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"27300030000515","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"Leader Quick Dissolve Glucose Tablet Chewable 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Leader Unifine Pentips 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Leader Unifine Pentips Plus 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25992002200330","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Leena Tablet 0.5/1/0.5-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5/1/0.5-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66280050000310","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Pyrimidine Synthesis Inhibitors","drug_name":"Leflunomide Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66280050000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Pyrimidine Synthesis Inhibitors","drug_name":"Leflunomide Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99394050000130","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Immunomodulators for Myelodysplastic Syndromes","drug_name":"Lenalidomide Capsule 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99394050000140","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Immunomodulators for Myelodysplastic Syndromes","drug_name":"Lenalidomide Capsule 15 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99394050000110","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Immunomodulators for Myelodysplastic Syndromes","drug_name":"Lenalidomide Capsule 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99394050000145","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Immunomodulators for Myelodysplastic Syndromes","drug_name":"Lenalidomide Capsule 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99394050000150","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Immunomodulators for Myelodysplastic Syndromes","drug_name":"Lenalidomide Capsule 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99394050000120","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Immunomodulators for Myelodysplastic Syndromes","drug_name":"Lenalidomide Capsule 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B220","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (10 MG Daily Dose) Capsule Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Lenvima (lenvatinib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B223","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (12 MG Daily Dose) Capsule Therapy Pack 3 x 4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3 x 4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B240","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (14 MG Daily Dose) Capsule Therapy Pack 10 & 4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Lenvima (lenvatinib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10 & 4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B244","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (18 MG Daily Dose) Capsule Therapy Pack 10 MG & 2 x 4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10 MG &","strength_unit_of_measure":"2 x 4 MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B230","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (20 MG Daily Dose) Capsule Therapy Pack 2 x 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Lenvima (lenvatinib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B250","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (24 MG Daily Dose) Capsule Therapy Pack 2 x 10 MG & 4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Lenvima (lenvatinib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 10 MG &","strength_unit_of_measure":"4 MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B210","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (4 MG Daily Dose) Capsule Therapy Pack 4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2133505420B215","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Vascular Endothelial Growth Factor (VEGF) Inhibitors","drug_name":"Lenvima (8 MG Daily Dose) Capsule Therapy Pack 2 x 4 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Lenvima (lenvatinib)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402860000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Aromatase Inhibitors","drug_name":"Letrozole Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21755040100325","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Folic Acid Antagonists Rescue Agents","drug_name":"Leucovorin Calcium Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21755040100335","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Folic Acid Antagonists Rescue Agents","drug_name":"Leucovorin Calcium Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21755040100345","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Folic Acid Antagonists Rescue Agents","drug_name":"Leucovorin Calcium Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21755040100310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Folic Acid Antagonists Rescue Agents","drug_name":"Leucovorin Calcium Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21101010000305","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Nitrogen Mustards and Related Analogues","drug_name":"Leukeran Tablet 2 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010106407","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Leuprolide Acetate Kit 1 MG/0.2ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/0.2ML","route":"Injection","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44201045102510","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Levalbuterol HCl Nebulization Solution 0.31 MG/3ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.31","strength_unit_of_measure":"MG/3ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201045102520","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Levalbuterol HCl Nebulization Solution 0.63 MG/3ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.63","strength_unit_of_measure":"MG/3ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201045102560","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Levalbuterol HCl Nebulization Solution 1.25 MG/0.5ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MG/0.5ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201045102530","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Levalbuterol HCl Nebulization Solution 1.25 MG/3ML Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MG/3ML","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44201045503220","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Beta Adrenergics","drug_name":"Levalbuterol Tartrate Aerosol 45 MCG/ACT Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043007520","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam ER Tablet Extended Release 24 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043007530","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam ER Tablet Extended Release 24 Hour 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043002020","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam Solution 100 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043002020","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam Solution 500 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043000350","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam Tablet 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043000320","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043000330","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600043000340","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"levETIRAcetam Tablet 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86250020102005","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Beta-blockers - Ophthalmic","drug_name":"Levobunolol HCl Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"80303093300340","therapeutic_category":"NUTRIENTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Amino Acids-Single","drug_name":"levOCARNitine Fumarate Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30903045102010","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Carnitine Replenisher - Agents","drug_name":"levOCARNitine Solution 1 GM/10ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM/10ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30903045100330","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Carnitine Replenisher - Agents","drug_name":"levOCARNitine Tablet 330 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"330","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41550027102020","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"Levocetirizine Dihydrochloride Solution 2.5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41550027100320","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"Levocetirizine Dihydrochloride Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000034112024","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin in D5W Solution 250 MG/50ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/50ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000034112028","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin in D5W Solution 500 MG/100ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/100ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000034112032","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin in D5W Solution 750 MG/150ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG/150ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101036002020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"levoFLOXacin Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"05000034002020","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin Solution 25 MG/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000034002050","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin Solution 25 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000034000320","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000034000330","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000034000340","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"levoFLOXacin Tablet 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78516022000127","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"Levomefolate DHA Capsule 27-1.13-0.4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1.13-0.4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25992002100310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Levonest Tablet 50-30/75-40/ 125-30 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-30/75-40/","strength_unit_of_measure":"125-30 MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300315","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Levonorgest-Eth Estrad 91-Day Tablet 0.1-0.02 & 0.01 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1-0.02 & 0.01","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300330","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Levonorgest-Eth Estrad 91-Day Tablet 0.15-0.03 &0.01 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15-0.03 &0.01","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Levonorgest-Eth Estrad 91-Day Tablet 0.15-0.03 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15-0.03","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003350320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Levonorgest-Eth Estradiol-Iron Tablet 0.1-20 MG-MCG(21) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1-20","strength_unit_of_measure":"MG-MCG(21)","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25400040000340","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Emergency Contraceptives","drug_name":"Levonorgestrel Tablet 1.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Levonorgestrel-Ethinyl Estrad Tablet 0.1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Levonorgestrel-Ethinyl Estrad Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25994002350320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Continuous Contraceptives - Oral","drug_name":"Levonorgestrel-Ethinyl Estrad Tablet 90-20 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"90-20","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Levora 0.15/30 (28) Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"28100010100320","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T Tablet 100 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100322","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T TABLET 112 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"112","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100325","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T Tablet 125 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100327","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T TABLET 137 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"137","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100330","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T TABLET 150 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100335","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T TABLET 175 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"175","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100340","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T TABLET 200 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100305","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T Tablet 25 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100345","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T TABLET 300 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T Tablet 50 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100315","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T Tablet 75 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100317","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levo-T TABLET 88 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"88","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100320","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 100 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100322","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 112 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"112","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100325","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 125 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100327","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 137 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"137","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100330","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 150 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100335","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 175 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"175","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100340","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 200 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100305","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 25 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100345","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 300 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 50 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100315","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 75 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100317","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levothyroxine Sodium Tablet 88 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"88","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100320","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 100 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100322","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 112 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"112","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100325","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 125 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100327","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 137 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"137","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100330","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 150 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100335","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 175 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"175","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100340","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 200 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100305","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 25 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 50 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100315","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 75 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100010100317","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Levoxyl TABLET 88 MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"88","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12104525101820","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Lexiva Suspension 50 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82801020003020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Amino Acids","drug_name":"L-Glutamine Packet 5 GM Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Endari","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"1"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90900035000910","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"Lice Treatment Liquid 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"69100040102011","therapeutic_category":"LOCAL ANESTHETICS-Parenteral (Medications that can suppress pain)","therapeutic_class":"Local Anesthetics - Amides","drug_name":"Lidocaine HCl (PF) Solution 1 % Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90850060104005","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Local Anesthetics - Topical","drug_name":"Lidocaine HCl Gel 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90850060102015","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Local Anesthetics - Topical","drug_name":"Lidocaine HCl Solution 4 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90850060004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Local Anesthetics - Topical","drug_name":"Lidocaine Ointment 5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"50","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90850060005930","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Local Anesthetics - Topical","drug_name":"Lidocaine Patch 5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Lidocaine patches (Lidoderm)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"External","dose_form":"Patch","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90859902903710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Topical Anesthetic Combinations","drug_name":"Lidocaine-Prilocaine Cream 2.5-2.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-2.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25200050005318","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - IUD","drug_name":"Liletta (52 MG) INTRAUTERINE DEVICE 18.6 MCG/DAY Intrauterine","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18.6","strength_unit_of_measure":"MCG/DAY","route":"Intrauterine","dose_form":"Intrauterine Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Lillow Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90900020004510","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"Lindane Shampoo 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Shampoo","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16230040001920","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Oxazolidinones","drug_name":"Linezolid Suspension Reconstituted 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16230040000330","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Oxazolidinones","drug_name":"Linezolid Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"28100020100310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Liothyronine Sodium Tablet 25 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100020100305","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Liothyronine Sodium Tablet 5 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100020100315","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Liothyronine Sodium Tablet 50 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79109902630150","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Liquid Calcium/Vitamin D Capsule 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000912","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Liquid Pain Relief Liquid 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"80200040001600","therapeutic_category":"NUTRIENTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Lipids","drug_name":"Liquigen Emulsion Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Emulsion","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717005000D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Liraglutide Solution Pen-Injector 18 MG/3ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"9","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6125205000D220","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Anti-Obesity - GLP-1 Receptor Agonists","drug_name":"Liraglutide -Weight Management Solution Pen-Injector 18 MG/3ML Subcutaneous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"15","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100025100110","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Lisdexamfetamine Dimesylate Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100025100120","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Lisdexamfetamine Dimesylate Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100025100130","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Lisdexamfetamine Dimesylate Capsule 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100025100140","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Lisdexamfetamine Dimesylate Capsule 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100025100150","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Lisdexamfetamine Dimesylate Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100025100160","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Lisdexamfetamine Dimesylate Capsule 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61100025100170","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Amphetamines","drug_name":"Lisdexamfetamine Dimesylate Capsule 70 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100030000310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Lisinopril Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100030000303","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Lisinopril Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100030000315","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Lisinopril Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100030000324","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Lisinopril Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100030000330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Lisinopril Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100030000305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Lisinopril Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802550305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Lisinopril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802550310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Lisinopril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802550320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Lisinopril-hydroCHLOROthiazide Tablet 20-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Litetouch Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Litetouch Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010000912","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Little Remedies for Fever Liquid 160 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Little Remedies Gas Relief Suspension 20 MG/0.3ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/0.3ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52780070500120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Peroxisome Proliferator-Activated Receptor Agonists","drug_name":"Livdelzi Capsule 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12200050000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"CMV Agents","drug_name":"Livtencity Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25991003500320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Biphasic Contraceptives - Oral","drug_name":"Lo Loestrin Fe Tablet 1 MG-10 MCG / 10 MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1 MG-10 MCG /","strength_unit_of_measure":"10 MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99450020003040","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Potassium Removing Agents","drug_name":"Lokelma Packet 10 GM Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99450020003020","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Potassium Removing Agents","drug_name":"Lokelma Packet 5 GM Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Long Lasting Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21990002750320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic Combinations","drug_name":"Lonsurf TABLET 15-6.14 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15-6.14","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21990002750330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic Combinations","drug_name":"Lonsurf TABLET 20-8.19 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20-8.19","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100105","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Loperamide HCl Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100905","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Loperamide HCl Liquid 1 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Loperamide HCl Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902552020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Lopinavir-Ritonavir Solution 400-100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902550310","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Lopinavir-Ritonavir Tablet 100-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902550320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Lopinavir-Ritonavir Tablet 200-50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200-50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120305","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Lopreeza Tablet 0.5-0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5-0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120310","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Lopreeza Tablet 1-0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41550030000320","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Non-Sedating","drug_name":"Loratadine Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21530556000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - ALK Inhibitors","drug_name":"Lorbrena Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21530556000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - ALK Inhibitors","drug_name":"Lorbrena Tablet 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"36150040200340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Losartan Potassium Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150040200320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Losartan Potassium Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150040200330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Losartan Potassium Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002450325","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Losartan Potassium-HCTZ Tablet 100-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002450340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Losartan Potassium-HCTZ Tablet 100-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002450320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Losartan Potassium-HCTZ Tablet 50-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400050000305","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Lovastatin Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400050000310","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Lovastatin Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400050000320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Lovastatin Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002900310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Low-Ogestrel Tablet 0.3-30 MG-MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.3-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79300020004715","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Lozi-Flur LOZENGE 2.2 (1 F) MG Mouth/Throat","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.2 (1 F)","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21532480000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - KRAS Inhibitors","drug_name":"Lumakras Tablet 120 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532480000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - KRAS Inhibitors","drug_name":"Lumakras Tablet 240 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532480000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - KRAS Inhibitors","drug_name":"Lumakras Tablet 320 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"320","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"62450060203020","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Anti-Cataplectic Agents","drug_name":"Lumryz Packet 4.5 GM Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4.5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62450060203025","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Anti-Cataplectic Agents","drug_name":"Lumryz Packet 6 GM Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62450060203030","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Anti-Cataplectic Agents","drug_name":"Lumryz Packet 7.5 GM Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62450060203035","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Anti-Cataplectic Agents","drug_name":"Lumryz Packet 9 GM Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402080000120","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"Lupkynis Capsule 7.9 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.9","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010106405","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Lupron Depot (1-Month) KIT 3.75 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3.75","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010106410","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Lupron Depot (1-Month) KIT 7.5 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010156420","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Lupron Depot (3-Month) KIT 11.25 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"11.25","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010156430","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Lupron Depot (3-Month) KIT 22.5 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22.5","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010206430","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Lupron Depot (4-Month) KIT 30 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405010256450","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"LHRH Analogs","drug_name":"Lupron Depot (6-Month) KIT 45 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30080050106430","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"LHRH/GnRH Agonist Analog Pituitary Suppressants","drug_name":"Lupron Depot-Ped (1-Month) Kit 11.25 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"11.25","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30080050106440","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"LHRH/GnRH Agonist Analog Pituitary Suppressants","drug_name":"Lupron Depot-Ped (1-Month) Kit 15 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30080050106420","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"LHRH/GnRH Agonist Analog Pituitary Suppressants","drug_name":"Lupron Depot-Ped (1-Month) Kit 7.5 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30080050156420","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"LHRH/GnRH Agonist Analog Pituitary Suppressants","drug_name":"Lupron Depot-Ped (3-Month) Kit 11.25 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"11.25","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30080050156440","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"LHRH/GnRH Agonist Analog Pituitary Suppressants","drug_name":"Lupron Depot-Ped (3-Month) Kit 30 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"LEUPROLIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30080050256460","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"LHRH/GnRH Agonist Analog Pituitary Suppressants","drug_name":"Lupron Depot-Ped (6-Month) Kit 45 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Lutera Tablet 0.1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21535560000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Poly (ADP-ribose) Polymerase (PARP) Inhibitors","drug_name":"Lynparza Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"1"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535560000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Poly (ADP-ribose) Polymerase (PARP) Inhibitors","drug_name":"Lynparza Tablet 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"1"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21402250000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiadrenals","drug_name":"Lysodren Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"2153222800B720","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Lytgobi (12 MG Daily Dose) Tablet Therapy Pack 4 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"84","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153222800B725","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Lytgobi (16 MG Daily Dose) Tablet Therapy Pack 4 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153222800B730","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Lytgobi (20 MG Daily Dose) Tablet Therapy Pack 4 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"140","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Lyza TABLET 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000515","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"Maalox Tablet Chewable 600 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010000110","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Capsule 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010360320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Oxide -Mg Supplement Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010360317","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Oxide -Mg Supplement Tablet 400 (240 Mg) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400 (240 Mg)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010360340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Oxide -Mg Supplement Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48400020000305","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Magnesium Salts","drug_name":"Magnesium Oxide Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010360318","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Oxide Tablet 400 (241.3 Mg) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400 (241.3 Mg)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48400020000310","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Magnesium Salts","drug_name":"Magnesium Oxide Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48400020000315","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Magnesium Salts","drug_name":"Magnesium Oxide Tablet 420 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"420","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010000310","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010000312","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010000315","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"Magnesium Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90900030004120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"Malathion Lotion 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"118","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000914","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Mapap Acetaminophen Extra Str Liquid 500 MG/15ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Mapap Arthritis Pain Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000115","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Mapap Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007210","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Mapap Childrens TABLET DISPERSIBLE 80 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000912","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Mapap Liquid 160 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Mapap Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Mapap Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12102060000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - CCR5 Antagonists (Entry Inhibitor)","drug_name":"Maraviroc Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12102060000330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - CCR5 Antagonists (Entry Inhibitor)","drug_name":"Maraviroc Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64991003100110","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics-Sedatives","drug_name":"Margesic Capsule 50-325-40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-325-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Marlissa Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21700050100105","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastics Misc.","drug_name":"Matulane Capsule 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107530","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Matzim LA Tablet Extended Release 24 Hour 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107540","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Matzim LA Tablet Extended Release 24 Hour 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107550","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Matzim LA Tablet Extended Release 24 Hour 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107560","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Matzim LA Tablet Extended Release 24 Hour 360 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"360","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000010107570","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"Matzim LA Tablet Extended Release 24 Hour 420 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"420","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240101500B744","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Antimetabolites","drug_name":"Mavenclad (10 Tabs) Tablet Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240101500B718","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Antimetabolites","drug_name":"Mavenclad (4 Tabs) Tablet Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240101500B722","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Antimetabolites","drug_name":"Mavenclad (5 Tabs) Tablet Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240101500B726","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Antimetabolites","drug_name":"Mavenclad (6 Tabs) Tablet Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240101500B732","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Antimetabolites","drug_name":"Mavenclad (7 Tabs) Tablet Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240101500B736","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Antimetabolites","drug_name":"Mavenclad (8 Tabs) Tablet Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240101500B740","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Antimetabolites","drug_name":"Mavenclad (9 Tabs) Tablet Therapy Pack 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12359902353020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agent - Combinations","drug_name":"Mavyret Packet 50-20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"140","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12359902350320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agent - Combinations","drug_name":"Mavyret Tablet 100-40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"168","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6240707020B720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Mayzent Starter Pack Tablet Therapy Pack 12 x 0.25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12 x 0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240707020B710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Mayzent Starter Pack Tablet Therapy Pack 7 x 0.25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7 x 0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62407070200320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Mayzent Tablet 0.25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62407070200330","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Mayzent Tablet 1 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62407070200340","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Mayzent Tablet 2 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000305","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Meclizine HCl Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Meclizine HCl Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000510","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Meclizine HCl Tablet Chewable 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Medi-Bismuth Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Medicine Shoppe Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Medicine Shoppe Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Medi-First Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200315","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Medi-Lax Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Medi-Natural Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Medi-Profen Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Medi-Profen Suspension 40 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Mediproxen Tablet 220 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Medique Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Medi-Tabs Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000515","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Medi-Tabs Junior Strength Tablet Chewable 160 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Medpura Hydrocortisone Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25150035101820","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Injectable","drug_name":"medroxyPROGESTERone Acetate Suspension 150 MG/ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2515003510E620","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Injectable","drug_name":"medroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000020200315","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"medroxyPROGESTERone Acetate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000020200305","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"medroxyPROGESTERone Acetate Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000020200310","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"MedroxyPROGESTERone Acetate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100050000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Mefenamic Acid Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13000025100310","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarials","drug_name":"Mefloquine HCl Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21404020101810","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Progestins-Antineoplastic","drug_name":"Megestrol Acetate Suspension 40 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21404020101810","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Progestins-Antineoplastic","drug_name":"Megestrol Acetate Suspension 400 MG/10ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG/10ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21404020100305","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Progestins-Antineoplastic","drug_name":"Megestrol Acetate Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21404020100310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Progestins-Antineoplastic","drug_name":"Megestrol Acetate Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Meijer Alcohol Swabs Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"Meijer Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Meijer Aspirin EC Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Meijer Aspirin Free Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Meijer Aspirin Free Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27309902400520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other - Combinations","drug_name":"Meijer Glucose Tablet Chewable 4-6 GM-MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4-6","strength_unit_of_measure":"GM-MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000515","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Meijer Jr St Aspirin Free Tablet Chewable 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Meijer Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Meijer Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Meijer Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21533570100310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Mekinist Tablet 0.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Mekinist"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533570100330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Mekinist Tablet 2 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Mekinist"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533520000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - MEK Inhibitors","drug_name":"Mektovi Tablet 15 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"95391536000360","therapeutic_category":"ALTERNATIVE MEDICINES (Herbal supplements)","therapeutic_class":"Alternative Medicine - Me's","drug_name":"Melatonin Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"95391536000340","therapeutic_category":"ALTERNATIVE MEDICINES (Herbal supplements)","therapeutic_class":"Alternative Medicine - Me's","drug_name":"Melatonin Tablet 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"95391536000350","therapeutic_category":"ALTERNATIVE MEDICINES (Herbal supplements)","therapeutic_class":"Alternative Medicine - Me's","drug_name":"Melatonin Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100052000330","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Meloxicam Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100052000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Meloxicam Tablet 7.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62053550102020","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"N-Methyl-D-Aspartate (NMDA) Receptor Antagonists","drug_name":"Memantine HCl Solution 2 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62053550100330","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"N-Methyl-D-Aspartate (NMDA) Receptor Antagonists","drug_name":"Memantine HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62053550100350","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"N-Methyl-D-Aspartate (NMDA) Receptor Antagonists","drug_name":"Memantine HCl Tablet 28 x 5 MG & 21 x 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28 x 5 MG &","strength_unit_of_measure":"21 x 10 MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62053550100320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"N-Methyl-D-Aspartate (NMDA) Receptor Antagonists","drug_name":"Memantine HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200040442200","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Menactra Injectable Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200040452000","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Menactra Solution Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000030000305","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Menest Tablet 0.3 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000030000310","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Menest Tablet 0.625 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.625","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000030000315","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Menest Tablet 1.25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24000030000320","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogens","drug_name":"Menest Tablet 2.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17209902502120","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccine Combinations","drug_name":"Menhibrix SOLUTION RECONSTITUTED 5-5-2.5 MCG Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5-5-2.5","strength_unit_of_measure":"MCG","route":"Intramuscular","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200040442200","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"MenQuadfi Injectable Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200040462000","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"MenQuadfi Solution 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200040482020","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Menveo Solution Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200040482100","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Menveo Solution Reconstituted Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100045100305","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Meperidine HCl Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"21300040000305","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Mercaptopurine Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2710400201D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Merilog SoloStar Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27104002012020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Merilog Solution 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16150050002140","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Carbapenems","drug_name":"Meropenem Solution Reconstituted 1 GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16150050002120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Carbapenems","drug_name":"Meropenem Solution Reconstituted 500 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52500030005105","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Inflammatory Bowel Agents","drug_name":"Mesalamine Enema 4 GM Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52500030007020","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Inflammatory Bowel Agents","drug_name":"Mesalamine ER Capsule Extended Release 24 Hour 0.375 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.375","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52500030005240","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Inflammatory Bowel Agents","drug_name":"Mesalamine Suppository 1000 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52500030000670","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Inflammatory Bowel Agents","drug_name":"Mesalamine Tablet Delayed Release 1.2 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.2","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52500030206420","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Inflammatory Bowel Agents","drug_name":"Mesalamine-Cleanser Kit 4 GM Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Rectal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27250050007590","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Biguanides","drug_name":"metFORMIN HCl ER (MOD) Tablet Extended Release 24 Hour 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27250050007520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Biguanides","drug_name":"metFORMIN HCl ER Tablet Extended Release 24 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27250050007530","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Biguanides","drug_name":"metFORMIN HCl ER Tablet Extended Release 24 Hour 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27250050000350","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Biguanides","drug_name":"metFORMIN HCl Tablet 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27250050000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Biguanides","drug_name":"metFORMIN HCl Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27250050000340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Biguanides","drug_name":"metFORMIN HCl Tablet 850 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"850","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"65100050101310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Methadone HCl Concentrate 10 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Concentrate","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100050102015","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Methadone HCl Solution 10 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100050102010","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Methadone HCl Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100050100310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Methadone HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100050100305","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Methadone HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"16800020200305","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Urinary Anti-infectives","drug_name":"Methenamine Hippurate Tablet 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16800020100310","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Urinary Anti-infectives","drug_name":"Methenamine Mandelate Tablet 0.5 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16800020100320","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Urinary Anti-infectives","drug_name":"Methenamine Mandelate Tablet 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"28300010000310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Antithyroid Agents","drug_name":"methIMAzole Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"28300010000305","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Antithyroid Agents","drug_name":"methIMAzole Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100070000305","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Methocarbamol Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100070000310","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Methocarbamol Tablet 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102075","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium (PF) Solution 1 GM/40ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM/40ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102065","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium (PF) Solution 100 MG/4ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/4ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102067","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium (PF) Solution 200 MG/8ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/8ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102069","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium (PF) Solution 250 MG/10ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/10ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102063","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium (PF) Solution 50 MG/2ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/2ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102068","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium SOLUTION 250 MG/10ML INJECTION","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/10ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102062","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium Solution 50 MG/2ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/2ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050102150","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium Solution Reconstituted 1 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050100310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Sodium Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300050100310","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Methotrexate Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72400020000110","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Succinimides","drug_name":"Methsuximide Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600055000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"Methyclothiazide Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201030000310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"Methyldopa Tablet 250 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36201030000315","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Centrally Acting","drug_name":"Methyldopa Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36995002700310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Adrenolytics-Central & Thiazide/Thiazide-Like Comb","drug_name":"Methyldopa-hydroCHLOROthiazide Tablet 250-15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36995002700320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Adrenolytics-Central & Thiazide/Thiazide-Like Comb","drug_name":"Methyldopa-hydroCHLOROthiazide Tablet 250-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"29000020100305","therapeutic_category":"OXYTOCICS (Medications to support uterine contractions)","therapeutic_class":"Oxytocics","drug_name":"Methylergonovine Maleate Tablet 0.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100210","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (CD) Capsule Extended Release 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100220","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (CD) Capsule Extended Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100230","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (CD) Capsule Extended Release 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100240","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (CD) Capsule Extended Release 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100250","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (CD) Capsule Extended Release 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100260","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (CD) Capsule Extended Release 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107010","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (LA) Capsule Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107020","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (LA) Capsule Extended Release 24 Hour 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107030","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (LA) Capsule Extended Release 24 Hour 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107040","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (LA) Capsule Extended Release 24 Hour 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107048","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (LA) Capsule Extended Release 24 Hour 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100460","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (OSM) Tablet Extended Release 18 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100465","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (OSM) Tablet Extended Release 27 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100470","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (OSM) Tablet Extended Release 36 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"36","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100480","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER (OSM) Tablet Extended Release 54 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"54","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100403","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER Tablet Extended Release 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100405","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER Tablet Extended Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107518","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER Tablet Extended Release 24 Hour 18 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107527","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER Tablet Extended Release 24 Hour 27 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107536","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER Tablet Extended Release 24 Hour 36 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"36","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020107554","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl ER Tablet Extended Release 24 Hour 54 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Attention Deficit Hyperactivity Disorder (ADHD) Stimulants: Vyvanse","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"54","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020102030","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Solution 10 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"900","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020102020","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1800","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100310","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100315","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100305","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100530","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Tablet Chewable 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100510","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Tablet Chewable 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61400020100520","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Stimulants - Misc.","drug_name":"Methylphenidate HCl Tablet Chewable 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100030000320","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"methylPREDNISolone Tablet 16 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"16","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100030000330","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"methylPREDNISolone Tablet 32 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100030000310","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"methylPREDNISolone Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100030000315","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"methylPREDNISolone Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2210003000B705","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"methylPREDNISolone Tablet Therapy Pack 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86250015102020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Beta-blockers - Ophthalmic","drug_name":"Metipranolol Solution 0.3 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52300020102013","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Gastrointestinal Stimulants","drug_name":"Metoclopramide HCl Solution 10 MG/10ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/10ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52300020102013","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Gastrointestinal Stimulants","drug_name":"Metoclopramide HCl Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52300020100305","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Gastrointestinal Stimulants","drug_name":"Metoclopramide HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52300020100303","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Gastrointestinal Stimulants","drug_name":"Metoclopramide HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"37600060000315","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"metOLazone Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600060000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"metOLazone Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37600060000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Thiazides and Thiazide-Like Diuretics","drug_name":"metOLazone Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200030057530","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Metoprolol Succinate ER Tablet Extended Release 24 Hour 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200030057540","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Metoprolol Succinate ER Tablet Extended Release 24 Hour 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200030057510","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Metoprolol Succinate ER Tablet Extended Release 24 Hour 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200030057520","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Metoprolol Succinate ER Tablet Extended Release 24 Hour 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200030100315","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Metoprolol Tartrate Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200030100305","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Metoprolol Tartrate Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200030100310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Metoprolol Tartrate Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002200320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Metoprolol-hydroCHLOROthiazide Tablet 100-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002200325","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Metoprolol-hydroCHLOROthiazide Tablet 100-50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002200310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Metoprolol-hydroCHLOROthiazide Tablet 50-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90060040004010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Rosacea Agents","drug_name":"metroNIDAZOLE Gel 0.75 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.75","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55100035004020","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Anti-infectives","drug_name":"metroNIDAZOLE Gel 0.75 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.75","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16000035000305","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Anti-infective Agents - Misc.","drug_name":"metroNIDAZOLE Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16000035000310","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Anti-infective Agents - Misc.","drug_name":"metroNIDAZOLE Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35200025100105","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-B","drug_name":"Mexiletine HCl Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35200025100110","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-B","drug_name":"Mexiletine HCl Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35200025100115","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-B","drug_name":"Mexiletine HCl Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550075004020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"MG217 Psoriasis Anit-Itch Gel 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002300555","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"Mi-Acid Tablet Chewable 700-300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"700-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106430","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole 1 Kit 1200 & 2 MG & % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1200 & 2","strength_unit_of_measure":"MG & %","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106464","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole 3 Combo Pack App Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106464","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole 3 Combo Pack Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050105210","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole 3 SUPPOSITORY 200 MG VAGINAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Vaginal","dose_form":"Suppository","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole 7 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050105205","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole 7 Suppository 100 MG Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Vaginal","dose_form":"Suppository","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole Nitrate Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050105205","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"Miconazole Nitrate Suppository 100 MG Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Vaginal","dose_form":"Suppository","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"Microchamber","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002600320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Microgestin 1.5/30 Tablet 1.5-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002600310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Microgestin 1/20 Tablet 1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Microgestin FE 1.5/30 Tablet 1.5-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Microgestin FE 1/20 Tablet 1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"Microspacer","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60201025102004","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Benzodiazepine Hypnotics","drug_name":"Midazolam HCl Solution 10 MG/10ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/10ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60201025102010","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Benzodiazepine Hypnotics","drug_name":"Midazolam HCl Solution 10 MG/2ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/2ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60201025102002","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Benzodiazepine Hypnotics","drug_name":"Midazolam HCl Solution 2 MG/2ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/2ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60201025102025","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Benzodiazepine Hypnotics","drug_name":"Midazolam HCl Solution 25 MG/5ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/5ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60201025102003","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Benzodiazepine Hypnotics","drug_name":"Midazolam HCl Solution 5 MG/5ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60201025102005","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Benzodiazepine Hypnotics","drug_name":"Midazolam HCl Solution 5 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60201025102050","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Benzodiazepine Hypnotics","drug_name":"Midazolam HCl Solution 50 MG/10ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/10ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"38000083100340","therapeutic_category":"VASOPRESSORS (Medications to increase blood pressure)","therapeutic_class":"Vasopressors","drug_name":"Midodrine HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"38000083100320","therapeutic_category":"VASOPRESSORS (Medications to increase blood pressure)","therapeutic_class":"Vasopressors","drug_name":"Midodrine HCl Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"38000083100330","therapeutic_category":"VASOPRESSORS (Medications to increase blood pressure)","therapeutic_class":"Vasopressors","drug_name":"Midodrine HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30502060000320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Abortifacient - Progesterone Receptor Antagonists","drug_name":"miFEPRIStone Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27500050000340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Alpha-Glucosidase Inhibitors","drug_name":"Miglitol Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27500050000310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Alpha-Glucosidase Inhibitors","drug_name":"Miglitol Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27500050000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Alpha-Glucosidase Inhibitors","drug_name":"Miglitol Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002950310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Mili Tablet 0.25-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120305","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Mimvey Lo Tablet 0.5-0.1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5-0.1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002120310","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Mimvey TABLET 1-0.5 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46400010001750","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Lubricant Laxatives","drug_name":"Mineral Oil Heavy Oil","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Oil","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46400010051750","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Lubricant Laxatives","drug_name":"Mineral Oil Light Oil","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Oil","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008510","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Minitran Patch 24 Hour 0.1 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008520","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Minitran Patch 24 Hour 0.2 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008540","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Minitran Patch 24 Hour 0.4 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008550","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Minitran Patch 24 Hour 0.6 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.6","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000040100110","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Minocycline HCl Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000040100105","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Minocycline HCl Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"04000040100107","therapeutic_category":"TETRACYCLINES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Tetracyclines","drug_name":"Minocycline HCl Capsule 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36400020000310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Vasodilators","drug_name":"Minoxidil Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36400020000305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Vasodilators","drug_name":"Minoxidil Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48991003100515","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid & Simethicone","drug_name":"Mintox Plus Tablet Chewable 200-200-25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-200-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54200050007520","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodics - Beta-3 Adrenergic Agonists","drug_name":"Mirabegron ER Tablet Extended Release 24 Hour 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54200050007530","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodics - Beta-3 Adrenergic Agonists","drug_name":"Mirabegron ER Tablet Extended Release 24 Hour 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"MiraLax Mix-In Pax Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"MiraLax Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25200050005320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - IUD","drug_name":"Mirena (52 MG) Intrauterine Device 20 MCG/DAY Intrauterine","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MCG/DAY","route":"Intrauterine","dose_form":"Intrauterine Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49250030000310","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Ulcer Drugs - Prostaglandins","drug_name":"miSOPROStol Tablet 100 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49250030000320","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Ulcer Drugs - Prostaglandins","drug_name":"miSOPROStol Tablet 200 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17109903102200","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccine Combinations","drug_name":"M-M-R II Injectable Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Subcutaneous","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710000240E637","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"mNexspike Suspension Prefilled Syringe 10 MCG/0.2ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/0.2ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21580015200120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Protease Activators","drug_name":"Modeyso Capsule 125 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100033100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Moexipril HCl Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100033100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Moexipril HCl Tablet 7.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550082103710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Mometasone Furoate Cream 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550082104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Mometasone Furoate Ointment 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550082102010","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Mometasone Furoate Solution 0.1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Monogen Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Bluntip Cannula 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020186320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Hypodermic Needle 18G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Hypodermic Needle 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020186320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Magellan Safety Ndl 18G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Magellan Safety Ndl 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Magellan Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036350","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Magellan Syringe 22G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036360","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Magellan Syringe 22G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Syringe 21G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036350","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Syringe 22G X 1\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051040036360","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Monoject Syringe 22G X 1-1/2\" 3 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22G X 1-1/2\"","strength_unit_of_measure":"3 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002950310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Mono-Linyah Tablet 0.25-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002950310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"MonoNessa Tablet 0.25-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44505050103020","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Leukotriene Receptor Antagonists","drug_name":"Montelukast Sodium Packet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44505050100330","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Leukotriene Receptor Antagonists","drug_name":"Montelukast Sodium Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44505050100516","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Leukotriene Receptor Antagonists","drug_name":"Montelukast Sodium Tablet Chewable 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44505050100520","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Leukotriene Receptor Antagonists","drug_name":"Montelukast Sodium Tablet Chewable 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"65100055102090","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate (Concentrate) Solution 10 MG/0.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/0.5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"O","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055102090","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate (Concentrate) Solution 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055107010","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Capsule Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055107020","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Capsule Extended Release 24 Hour 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055107040","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Capsule Extended Release 24 Hour 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055100460","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Tablet Extended Release 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055100415","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Tablet Extended Release 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055100480","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Tablet Extended Release 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055100432","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Tablet Extended Release 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055100445","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate ER Tablet Extended Release 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055102004","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate Solution 1 MG/ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055102065","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate Solution 10 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055102070","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate Solution 20 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055100310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100055100315","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Morphine Sulfate Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Motion Sickness Relief Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000510","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Motion Sickness Relief Tablet Chewable 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"Motion Sickness Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101038102020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Moxifloxacin HCl Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000037100320","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Moxifloxacin HCl Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710007205E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"MResvia Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405045000320","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Mulpleta Tablet 3 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"7","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35400028100320","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Multaq Tablet 400 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000322","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Multi Prenatal Tablet 27-0.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78410000000900","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Pediatric Multiple Vitamins","drug_name":"Multi-Delyn Liquid Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78450000002008","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multi Vitamins w/Fl & FE","drug_name":"Multi-Vit/Iron/Fluoride Solution 0.25-10 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25-10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78400000000500","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Pediatric Vitamins","drug_name":"Multivitamin Gummies Childrens Tablet Chewable Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78310000000900","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Multiple Vitamins w/ Minerals","drug_name":"Multivitamin Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000002005","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Multi-Vitamin/Fluoride Solution 0.25 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000002010","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Multi-Vitamin/Fluoride Solution 0.5 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000000505","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Multivitamin/Fluoride Tablet Chewable 0.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000000510","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Multivitamin/Fluoride Tablet Chewable 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000000520","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Multivitamin/Fluoride Tablet Chewable 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90100065104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"Mupirocin Ointment 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25400040000340","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Emergency Contraceptives","drug_name":"My Way Tablet 1.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11500050102130","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungal - Glucan Synthesis Inhibitors (Echinocandins)","drug_name":"Mycamine Solution Reconstituted 100 MG Intravenous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11500050102120","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungal - Glucan Synthesis Inhibitors (Echinocandins)","drug_name":"Mycamine Solution Reconstituted 50 MG Intravenous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99403030100120","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Inosine Monophosphate Dehydrogenase Inhibitors","drug_name":"Mycophenolate Mofetil Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99403030100330","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Inosine Monophosphate Dehydrogenase Inhibitors","drug_name":"Mycophenolate Mofetil Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99403030300620","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Inosine Monophosphate Dehydrogenase Inhibitors","drug_name":"Mycophenolate Sodium Tablet Delayed Release 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99403030300630","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Inosine Monophosphate Dehydrogenase Inhibitors","drug_name":"Mycophenolate Sodium Tablet Delayed Release 360 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"360","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512015000366","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Mynatal Plus Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512070000475","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Mynate 90 Plus Tablet Extended Release Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90050013000120","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Acne Products","drug_name":"Myorisan Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46992003602020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bowel Evacuant Combinations","drug_name":"Na Sulfate-K Sulfate-Mg Sulf Solution 17.5-3.13-1.6 GM/177ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"17.5-3.13-1.6","strength_unit_of_measure":"GM/177ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100055000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Nabumetone Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100055000330","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Nabumetone Tablet 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33100010000303","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Nadolol Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100010000305","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Nadolol Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100010000310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Nadolol Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002300310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Nadolol-Bendroflumethiazide Tablet 40-5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36992002300320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Beta Blocker & Diuretic Combinations","drug_name":"Nadolol-Bendroflumethiazide Tablet 80-5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80-5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"01300040102105","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Nafcillin Sodium Solution Reconstituted 1 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01300040102127","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Nafcillin Sodium Solution Reconstituted 10 GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01300040102115","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Nafcillin Sodium Solution Reconstituted 2 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79300020000515","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"NaFrinse Tablet Chewable 2.2 (1 F) MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.2 (1 F)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90150078003710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical","drug_name":"Naftifine HCl Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90150078003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical","drug_name":"Naftifine HCl Cream 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93400020100920","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Naloxone HCl Liquid 4 MG/0.1ML Nasal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG/0.1ML","route":"Nasal","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93400020102010","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Naloxone HCl Solution 0.4 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9340002010E210","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Naloxone HCl Solution Cartridge 0.4 MG/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"MG/ML","route":"Injection","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9340002010E540","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Naloxone HCl Solution Prefilled Syringe 2 MG/2ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/2ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93400030100305","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Naltrexone HCl Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060000615","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen DR Tablet Delayed Release 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100127","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Sodium Capsule 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Sodium Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100305","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Sodium Tablet 275 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"275","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100310","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Sodium Tablet 550 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"550","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060001805","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Suspension 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060000305","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060000310","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Tablet 375 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"375","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060000315","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060000610","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Naproxen Tablet Delayed Release 375 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"375","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406050100310","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Naratriptan HCl TABLET 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":"Triptans: Zolmitriptan","step_therapy_step_2_number":"1"}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406050100320","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Naratriptan HCl Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":"Triptans: Zolmitriptan","step_therapy_step_2_number":"1"}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25992402400320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Four Phase Contraceptives - Oral","drug_name":"Natazia TABLET 3/2-2/2-3/1 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3/2-2/2-3/1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27280040000330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Meglitinide Analogues","drug_name":"Nateglinide Tablet 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27280040000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Meglitinide Analogues","drug_name":"Nateglinide Tablet 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46300030102958","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bulk Laxatives","drug_name":"Natural Fiber Powder 58.6 % Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"58.6","strength_unit_of_measure":"%","route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"28100050000324","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 113.75 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"113.75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000328","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 130 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"130","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000370","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 146.25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"146.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000308","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 16.25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"16.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000329","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 162.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"162.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000333","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 195 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"195","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000337","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 260 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"260","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000313","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 32.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000345","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 325 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000314","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 48.75 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"48.75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000318","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 65 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"65","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000319","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 81.25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"81.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28100050000322","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Thyroid Hormones","drug_name":"Nature-Throid Tablet 97.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"97.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72100060002010","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Benzodiazepines","drug_name":"Nayzilam Solution 5 MG/0.1ML Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/0.1ML","route":"Nasal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33200040100330","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Nebivolol HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200040100310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Nebivolol HCl Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200040100340","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Nebivolol HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33200040100320","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Cardio-Selective","drug_name":"Nebivolol HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002500310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Necon 0.5/35 (28) Tablet 0.5-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002500320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Necon 1/35 (28) Tablet 1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25991002200310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Biphasic Contraceptives - Oral","drug_name":"Necon 10/11 (28) Tablet 35 MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"35","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25992002200310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Necon 7/7/7 Tablet 0.5/0.75/1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5/0.75/1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9079355510D420","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Interleukin-31 Receptor Antagonists - Systemic","drug_name":"Nemluvio Auto-Injector 30 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Neocate Infant DHA/ARA Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Neocate Junior Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Neocate Junior Prebiotics Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Neocate Nutra Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Neocate Splash Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Neocate Syneo Junior Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"07000040100305","therapeutic_category":"AMINOGLYCOSIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminoglycosides","drug_name":"Neomycin Sulfate Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86109903104220","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Anti-infective Combinations","drug_name":"Neomycin-Bacitracin Zn-Polymyx Ointment 5-400-10000 Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-400-10000","strength_unit_of_measure":null,"route":"Ophthalmic","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56701002102000","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Anti-infective Genitourinary Irrigants","drug_name":"Neomycin-Polymyxin B GU Solution 40-200000 Irrigation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-200000","strength_unit_of_measure":null,"route":"Irrigation","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86309903324210","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroid Combinations","drug_name":"Neomycin-Polymyxin-Dexameth Ointment 3.5-10000-0.1 Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.5-10000-0.1","strength_unit_of_measure":null,"route":"Ophthalmic","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86309903321810","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroid Combinations","drug_name":"Neomycin-Polymyxin-Dexameth Suspension 3.5-10000-0.1 Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.5-10000-0.1","strength_unit_of_measure":null,"route":"Ophthalmic","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86109903202000","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Anti-infective Combinations","drug_name":"Neomycin-Polymyxin-Gramicidin Solution 1.75-10000-.025 Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.75-10000-.025","strength_unit_of_measure":null,"route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87991003102010","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Steroid-Anti-infective Combinations","drug_name":"Neomycin-Polymyxin-HC Solution 3.5-10000-1 Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.5-10000-1","strength_unit_of_measure":null,"route":"Otic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86309903341810","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroid Combinations","drug_name":"Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.5-10000-1","strength_unit_of_measure":null,"route":"Ophthalmic","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87991003101807","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Steroid-Anti-infective Combinations","drug_name":"Neomycin-Polymyxin-HC Suspension 3.5-10000-1 Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.5-10000-1","strength_unit_of_measure":null,"route":"Otic","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Nepro Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21533035100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Nerlynx Tablet 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"12109050007510","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Nevirapine ER Tablet Extended Release 24 Hour 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109050007520","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Nevirapine ER Tablet Extended Release 24 Hour 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109050001820","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Nevirapine Suspension 50 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109050000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Nevirapine Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25300005002320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Implants","drug_name":"Nexplanon Implant 68 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"68","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Implant","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25400040000340","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Emergency Contraceptives","drug_name":"Next Choice One Dose Tablet 1.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002140320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Nextstellis Tablet 3-14.2 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3-14.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010001500D220","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Ngenla Solution Pen-Injector 24 MG/1.2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"24","strength_unit_of_measure":"MG/1.2ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010001500D240","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Ngenla Solution Pen-Injector 60 MG/1.2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/1.2ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39450050000470","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Nicotinic Acid Derivatives","drug_name":"Niacin ER (Antihyperlipidemic) Tablet Extended Release 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39450050000450","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Nicotinic Acid Derivatives","drug_name":"Niacin ER (Antihyperlipidemic) Tablet Extended Release 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77103010000210","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin ER Capsule Extended Release 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000220","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin ER Capsule Extended Release 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000440","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin ER Tablet Extended Release 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000450","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin ER Tablet Extended Release 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000460","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin ER Tablet Extended Release 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"40100025100120","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Peripheral Vasodilators","drug_name":"Niacin Flush Free Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77103010000330","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000340","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000320","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000350","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103020000310","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacinamide Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103020000315","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"Niacinamide Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39450050000350","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Nicotinic Acid Derivatives","drug_name":"Niacor Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicorelief Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005006430","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Kit 21-14-7 MG/24HR Transdermal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21-14-7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Patch 24 Hour 14 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Patch 24 Hour 21 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002820","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Polacrilex Gum 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Polacrilex Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Step 1 Patch 24 Hour 21 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Step 2 Patch 24 Hour 14 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotine Step 3 Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005002410","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotrol Inhaler 10 MG Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5760","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Inhalation","dose_form":"Inhaler","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005002020","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"Nicotrol NS Solution 10 MG/ML Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"720","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Nasal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020000105","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020000110","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020007570","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020007575","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020007580","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine ER Osmotic Release Tablet Extended Release 24 Hour 90 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020007530","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine ER Tablet Extended Release 24 Hour 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020007540","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine ER Tablet Extended Release 24 Hour 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000020007550","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"NIFEdipine ER Tablet Extended Release 24 Hour 90 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002150316","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Nikki Tablet 3-0.02 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3-0.02","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531860200115","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Nilotinib HCl Capsule 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531860200125","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Nilotinib HCl Capsule 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21531860200110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Nilotinib HCl Capsule 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21402460000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiandrogens","drug_name":"Nilutamide Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"34000022000120","therapeutic_category":"CALCIUM CHANNEL BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Calcium Channel Blockers","drug_name":"niMODipine Capsule 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21536045100120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Proteasome Inhibitors","drug_name":"Ninlaro Capsule 2.3 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21536045100130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Proteasome Inhibitors","drug_name":"Ninlaro Capsule 3 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21536045100140","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Proteasome Inhibitors","drug_name":"Ninlaro Capsule 4 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16400060000330","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Antiprotozoal Agents","drug_name":"Nitazoxanide Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30904045000130","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hereditary Tyrosinemia Type 1 (HT-1) Treatment - Agents","drug_name":"Nitisinone Capsule 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30904045000110","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hereditary Tyrosinemia Type 1 (HT-1) Treatment - Agents","drug_name":"Nitisinone Capsule 2 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30904045000140","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hereditary Tyrosinemia Type 1 (HT-1) Treatment - Agents","drug_name":"Nitisinone Capsule 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30904045000120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hereditary Tyrosinemia Type 1 (HT-1) Treatment - Agents","drug_name":"Nitisinone Capsule 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16800050100120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Urinary Anti-infectives","drug_name":"Nitrofurantoin Macrocrystal Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16800050100115","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Urinary Anti-infectives","drug_name":"Nitrofurantoin Macrocrystal Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16800050150120","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Urinary Anti-infectives","drug_name":"Nitrofurantoin Monohyd Macro Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16800050001810","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Urinary Anti-infectives","drug_name":"Nitrofurantoin Suspension 25 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008510","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Patch 24 Hour 0.1 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008520","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Patch 24 Hour 0.2 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.2","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008540","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Patch 24 Hour 0.4 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030008550","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Patch 24 Hour 0.6 MG/HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.6","strength_unit_of_measure":"MG/HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030002060","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Solution 0.4 MG/SPRAY Translingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"MG/SPRAY","route":"Translingual","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030000710","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Tablet Sublingual 0.3 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Tablet Sublingual","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030000715","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Tablet Sublingual 0.4 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Tablet Sublingual","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030000720","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"Nitroglycerin Tablet Sublingual 0.6 MG Sublingual","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.6","strength_unit_of_measure":"MG","route":"Sublingual","dose_form":"Tablet Sublingual","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32100030003460","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Nitrates","drug_name":"NitroMist Aerosol Solution 400 MCG/SPRAY Translingual","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MCG/SPRAY","route":"Translingual","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401520102020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Granulocyte Colony-Stimulating Factors (G-CSF)","drug_name":"Nivestym Solution 300 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401520102030","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Granulocyte Colony-Stimulating Factors (G-CSF)","drug_name":"Nivestym Solution 480 MCG/1.6ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"480","strength_unit_of_measure":"MCG/1.6ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240152010E520","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Granulocyte Colony-Stimulating Factors (G-CSF)","drug_name":"Nivestym Solution Prefilled Syringe 300 MCG/0.5ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240152010E530","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Granulocyte Colony-Stimulating Factors (G-CSF)","drug_name":"Nivestym Solution Prefilled Syringe 480 MCG/0.8ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"480","strength_unit_of_measure":"MCG/0.8ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49200040000110","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Nizatidine Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200040000120","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Nizatidine Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49200040002050","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"Nizatidine Solution 15 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020186320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"NOKOR Vented Needle 18G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Non-Aspirin Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000515","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Non-Aspirin Jr Strength Tablet Chewable 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Non-Aspirin Pain Relief Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Non-Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"96686642450900","therapeutic_category":"CHEMICALS (Miscellaneous liquid therapeutic agents)","therapeutic_class":"Bulk Chemicals - No's","drug_name":"Nonoxynol-9 Liquid","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002056","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Norditropin FlexPro SOLUTION 10 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002062","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Norditropin FlexPro SOLUTION 15 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002066","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Norditropin FlexPro SOLUTION 30 MG/3ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002050","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Norditropin FlexPro SOLUTION 5 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610112","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Norethin Ace-Eth Estrad-FE Capsule 1-20 MG-MCG(24) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG(24)","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610312","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Norethin Ace-Eth Estrad-FE Tablet 1-20 MG-MCG(24) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG(24)","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003610512","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Norethin Ace-Eth Estrad-FE Tablet Chewable 1-20 MG-MCG(24) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-20","strength_unit_of_measure":"MG-MCG(24)","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000030100305","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"Norethindrone Acetate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100010000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Norethindrone Tablet 0.35 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.35","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002250305","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Norethindrone-Eth Estradiol Tablet 0.5-2.5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5-2.5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002250310","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Norethindrone-Eth Estradiol Tablet 1-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003600520","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Norethin-Eth Estradiol-Fe Tablet Chewable 0.4-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.4-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003600540","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Norethin-Eth Estradiol-Fe Tablet Chewable 0.8-25 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.8-25","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002950310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Norgestimate-Eth Estradiol Tablet 0.25-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25992002300310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-25 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.18/0.215/0.25","strength_unit_of_measure":"MG-25 MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25992002300320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Norgestim-Eth Estrad Triphasic Tablet 0.18/0.215/0.25 MG-35 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.18/0.215/0.25","strength_unit_of_measure":"MG-35 MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010102024","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Normal Saline Flush Solution 0.9 % Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35100010106910","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-A","drug_name":"Norpace CR Capsule Extended Release 12 Hour 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35100010106915","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-A","drug_name":"Norpace CR Capsule Extended Release 12 Hour 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010001820","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Nortemp Infants Suspension 80 MG/0.8ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG/0.8ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002500310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Nortrel 0.5/35 (28) Tablet 0.5-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002500320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Nortrel 1/35 (21) TABLET 1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002500320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Nortrel 1/35 (28) Tablet 1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25992002200310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Triphasic Contraceptives - Oral","drug_name":"Nortrel 7/7/7 TABLET 0.5/0.75/1-35 MG-MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5/0.75/1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104560000120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Norvir Capsule 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104560003020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Norvir Packet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104560002020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Norvir Solution 80 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"NovaSource Renal Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710409000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN 70/30 FlexPen Relion Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710409000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN 70/30 FlexPen Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104090001810","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN 70/30 ReliOn Suspension (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104090001810","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN 70/30 Suspension (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710402000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN N FlexPen ReliOn Suspension Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710402000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN N FlexPen Suspension Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104020001805","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN N ReliOn Suspension 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104020001805","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN N Suspension 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710401000D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN R FlexPen ReliOn Solution Pen-Injector 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710401000D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN R FlexPen Solution Pen-Injector 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104010002005","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN R ReliOn Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104010002005","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLIN R Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400200D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLOG FlexPen Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710407000D320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLOG Mix 70/30 FlexPen Suspension Pen-Injector (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27104070001820","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLOG Mix 70/30 Suspension (70-30) 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"(70-30) 100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"2710400200E220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLOG PenFill Solution Cartridge 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27104002002022","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"NovoLOG Solution 100 UNIT/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050126220","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"NovoPen Echo DEVICE","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"90"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405060002110","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Nplate Solution Reconstituted 125 MCG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405060002120","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Nplate SOLUTION RECONSTITUTED 250 MCG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MCG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405060002130","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Nplate SOLUTION RECONSTITUTED 500 MCG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MCG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402425000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiandrogens","drug_name":"Nubeqa Tablet 300 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4460405500D530","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Interleukin-5 Antagonists (IgG1 kappa)","drug_name":"Nucala Solution Auto-Injector 100 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4460405500E530","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Interleukin-5 Antagonists (IgG1 kappa)","drug_name":"Nucala Solution Prefilled Syringe 100 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44604055002120","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Interleukin-5 Antagonists (IgG1 kappa)","drug_name":"Nucala Solution Reconstituted 100 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300050000110","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"Nu-Iron Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67701060707220","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Calcitonin Gene-Related Peptide Receptor Antag (CGRP)","drug_name":"Nurtec Tablet Dispersible 75 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000910","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Nutren 1.5 Liquid Enteral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Enteral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Nutren Jr Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Nutren Pulmonary Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512000000306","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Nutricion Porvida TABLET 0.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"30100020002020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Nutropin AQ NuSpin 10 SOLUTION 10 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002064","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Nutropin AQ NuSpin 20 SOLUTION 20 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002015","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Nutropin AQ NuSpin 5 SOLUTION 5 MG/2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90150080003710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical","drug_name":"Nystatin Cream 100000 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100000","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90150080004215","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical","drug_name":"Nystatin Ointment 100000 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100000","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"88100010001805","therapeutic_category":"MOUTH/THROAT/DENTAL AGENTS (Medications to treat inflammation, pain or other conditions in the mouth)","therapeutic_class":"Anti-infectives - Throat","drug_name":"Nystatin Suspension 100000 UNIT/ML Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100000","strength_unit_of_measure":"UNIT/ML","route":"Mouth/Throat","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11000060000305","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Antifungals","drug_name":"Nystatin Tablet 500000 UNIT Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500000","strength_unit_of_measure":"UNIT","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90159902253700","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical Combinations","drug_name":"Nystatin-Triamcinolone Cream 100000-0.1 UNIT/GM-% External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100000-0.1","strength_unit_of_measure":"UNIT/GM-%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90159902254200","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antifungals - Topical Combinations","drug_name":"Nystatin-Triamcinolone Ointment 100000-0.1 UNIT/GM-% External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100000-0.1","strength_unit_of_measure":"UNIT/GM-%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8240157002E520","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Granulocyte Colony-Stimulating Factors (G-CSF)","drug_name":"Nyvepria Solution Prefilled Syringe 6 MG/0.6ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG/0.6ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52750060000330","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Farnesoid X Receptor (FXR) Agonists","drug_name":"Ocaliva TABLET 10 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52750060000320","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Farnesoid X Receptor (FXR) Agonists","drug_name":"Ocaliva TABLET 5 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002150320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Ocella Tablet 3-0.03 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3-0.03","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070106410","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Kit 10 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070106420","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Kit 20 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070106430","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Kit 30 MG Intramuscular","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Intramuscular","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070102010","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution 100 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070102030","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution 1000 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070102015","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution 200 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070102005","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution 50 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170070102020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution 500 MCG/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3017007010E510","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution Prefilled Syringe 100 MCG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3017007010E505","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution Prefilled Syringe 50 MCG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3017007010E520","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Octreotide Acetate Solution Prefilled Syringe 500 MCG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OCTREOTIDE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MCG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109903390320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Odefsey Tablet 200-25-25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-25-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21370060200120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Hedgehog Pathway Inhibitors","drug_name":"Odomzo Capsule 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"45554050200120","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Pulmonary Fibrosis Agents - Kinase Inhibitors","drug_name":"Ofev CAPSULE 100 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45554050200130","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Pulmonary Fibrosis Agents - Kinase Inhibitors","drug_name":"Ofev CAPSULE 150 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86101047002020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antibiotics","drug_name":"Ofloxacin Solution 0.3 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"87100060002010","therapeutic_category":"OTIC AGENTS (Medications to treat pain, inflammation and infection of the ear)","therapeutic_class":"Otic Anti-infectives","drug_name":"Ofloxacin Solution 0.3 % Otic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"%","route":"Otic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"05000050000340","therapeutic_category":"FLUOROQUINOLONES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Fluoroquinolones","drug_name":"Ofloxacin Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002900320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Ogestrel Tablet 0.5-50 MG-MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5-50","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532350200320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Gamma Secretase Inhibitors","drug_name":"Ogsiveo Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21532075001920","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BRAF Kinase Inhibitors","drug_name":"Ojemda Suspension Reconstituted 25 MG/ML Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"96","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532075000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BRAF Kinase Inhibitors","drug_name":"Ojemda Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"24","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21537540300320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Ojjaara Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21537540300330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Ojjaara Tablet 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21537540300340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Janus Associated Kinase (JAK) Inhibitors","drug_name":"Ojjaara Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36150055200340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Olmesartan Medoxomil Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150055200360","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Olmesartan Medoxomil Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36150055200320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antagonists","drug_name":"Olmesartan Medoxomil Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002500320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Olmesartan Medoxomil-HCTZ Tablet 20-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002500340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Olmesartan Medoxomil-HCTZ Tablet 40-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Angiotensin Receptor Blockers (ARBs) & Combinations","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994002500345","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Antag & Thiazide/Thiazide-Like","drug_name":"Olmesartan Medoxomil-HCTZ Tablet 40-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Angiotensin Receptor Blockers (ARBs) & Combinations","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994503450310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Ant-Ca Channel Blocker-Thiazides","drug_name":"Olmesartan-amLODIPine-HCTZ Tablet 20-5-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-5-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994503450340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Ant-Ca Channel Blocker-Thiazides","drug_name":"Olmesartan-amLODIPine-HCTZ Tablet 40-10-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-10-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994503450350","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Ant-Ca Channel Blocker-Thiazides","drug_name":"Olmesartan-amLODIPine-HCTZ Tablet 40-10-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-10-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994503450320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Ant-Ca Channel Blocker-Thiazides","drug_name":"Olmesartan-amLODIPine-HCTZ Tablet 40-5-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-5-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36994503450330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Angiotensin II Receptor Ant-Ca Channel Blocker-Thiazides","drug_name":"Olmesartan-amLODIPine-HCTZ Tablet 40-5-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40-5-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86802065102020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Antiallergic","drug_name":"Olopatadine HCl Solution 0.1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"25"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66603010000310","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Antirheumatic - Janus Kinase (JAK) Inhibitors","drug_name":"Olumiant Tablet 1 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66603010000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Antirheumatic - Janus Kinase (JAK) Inhibitors","drug_name":"Olumiant Tablet 2 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39500045200130","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"Antihyperlipidemics - Misc.","drug_name":"Omega-3-acid Ethyl Esters Capsule 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270060006510","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Omeprazole Capsule Delayed Release 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270060006520","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Omeprazole Capsule Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270060006530","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Omeprazole Capsule Delayed Release 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270060106520","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20.6 (20 Base)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270060100620","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Omeprazole Magnesium Tablet Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270060000620","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Omeprazole Tablet Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"4927006000H320","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Omeprazole Tablet Delayed Release Dispersible 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97402000005400","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Diaphragms","drug_name":"Omniflex Diaphragm DIAPHRAGM VAGINAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Vaginal","dose_form":"Diaphragm","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97201030506400","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Insulin Administration Supplies","drug_name":"Omnipod 5 DexG7G6 Intro Gen 5 Kit","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97201030506300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Insulin Administration Supplies","drug_name":"Omnipod 5 DexG7G6 Pods Gen 5","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97201030506400","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Insulin Administration Supplies","drug_name":"Omnipod 5 G7 Intro (Gen 5) Kit","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97201030506300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Insulin Administration Supplies","drug_name":"Omnipod 5 G7 Pods (Gen 5)","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97201030506300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Insulin Administration Supplies","drug_name":"Omnipod Classic Pods (Gen 3)","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97201030506400","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Insulin Administration Supplies","drug_name":"Omnipod DASH PDM (Gen 4) Kit","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97201030506300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Insulin Administration Supplies","drug_name":"Omnipod DASH Pods (Gen 4)","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002056","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Omnitrope SOLUTION 10 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002050","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Omnitrope SOLUTION 5 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020002123","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Omnitrope SOLUTION RECONSTITUTED 5.8 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5.8","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94101024356400","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Infection Tests","drug_name":"On/Go Covid-19 Antigen Test Kit In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50250065052070","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"5-HT3 Receptor Antagonists","drug_name":"Ondansetron HCl Solution 4 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50250065050310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"5-HT3 Receptor Antagonists","drug_name":"Ondansetron HCl Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50250065050320","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"5-HT3 Receptor Antagonists","drug_name":"Ondansetron HCl Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50250065007220","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"5-HT3 Receptor Antagonists","drug_name":"Ondansetron Tablet Dispersible 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50250065007240","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"5-HT3 Receptor Antagonists","drug_name":"Ondansetron Tablet Dispersible 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73153060000120","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Peripheral COMT Inhibitors","drug_name":"Ongentys Capsule 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300003000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Onureg Tablet 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"14","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21300003000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antimetabolites","drug_name":"Onureg Tablet 300 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"14","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100020000305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Opill Tablet 0.075 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.075","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"OptiChamber Diamond","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"OptiChamber Diamond-Lg Mask Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"OptiChamber Diamond-Md Mask","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"OptiChamber Diamond-Sm Mask","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55300010004030","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Spermicides","drug_name":"Options Gynol II Contraceptive Gel 3 % Vaginal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93400018102060","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Opvee Solution 2.7 MG/0.1ML Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.7","strength_unit_of_measure":"MG/0.1ML","route":"Nasal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90272060503720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Atopic Dermatitis - Janus Kinase (JAK) Inhibitors","drug_name":"Opzelura Cream 1.5 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"480","quantity_limit_days":"56"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040207215","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Orapred ODT Tablet Dispersible 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040207220","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Orapred ODT Tablet Dispersible 15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040207240","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Orapred ODT Tablet Dispersible 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6640001000D520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Selective Costimulation Modulators","drug_name":"Orencia ClickJect Solution Auto-injector 125 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORENCIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6640001000E520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Selective Costimulation Modulators","drug_name":"Orencia Solution Prefilled Syringe 125 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORENCIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6640001000E510","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Selective Costimulation Modulators","drug_name":"Orencia Solution Prefilled Syringe 50 MG/0.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/0.4ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6640001000E515","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Selective Costimulation Modulators","drug_name":"Orencia Solution Prefilled Syringe 87.5 MG/0.7ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"87.5","strength_unit_of_measure":"MG/0.7ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4017008005C110","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Month 1 Tablet Extended Release Therapy Pack 0.125 & 0.25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"168","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.125 & 0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4017008005C120","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Month 2 Tablet Extended Release Therapy Pack 0.125 & 0.25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"336","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.125 & 0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"4017008005C130","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Month 3 Tablet Extended Release Therapy Pack 0.125 & 0.25 &1 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"252","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.125 & 0.25 &1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080050410","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Tablet Extended Release 0.125 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Orenitram (treprostinil)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"500","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080050415","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Tablet Extended Release 0.25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Orenitram (treprostinil)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"500","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080050420","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Tablet Extended Release 1 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Orenitram (treprostinil)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"500","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080050425","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Tablet Extended Release 2.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Orenitram (treprostinil)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"500","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080050435","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Orenitram Tablet Extended Release 5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"500","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30904045001820","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hereditary Tyrosinemia Type 1 (HT-1) Treatment - Agents","drug_name":"Orfadin Suspension 4 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"ORFADIN"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21405570000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Gonadotropin Releasing Hormone (GnRH) Antagonists","drug_name":"Orgovyx Tablet 120 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2499350340B220","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen-Progestin-GnRH Antagonist","drug_name":"Oriahnn Capsule Therapy Pack 300-1-0.5 & 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300-1-0.5 & 300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30090030100320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"GnRH/LHRH Antagonists","drug_name":"Orilissa Tablet 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30090030100330","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"GnRH/LHRH Antagonists","drug_name":"Orilissa Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45309902303010","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agent - Combinations","drug_name":"Orkambi Packet 100-125 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45309902303020","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agent - Combinations","drug_name":"Orkambi Packet 150-188 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150-188","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45309902303005","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agent - Combinations","drug_name":"Orkambi Packet 75-94 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75-94","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45309902300310","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agent - Combinations","drug_name":"Orkambi TABLET 100-125 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100-125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45309902300320","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Cystic Fibrosis Agent - Combinations","drug_name":"Orkambi TABLET 200-125 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"112","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200-125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85840010200120","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Plasma Kallikrein Inhibitors","drug_name":"Orladeyo Capsule 110 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"110","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85840010200130","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Plasma Kallikrein Inhibitors","drug_name":"Orladeyo Capsule 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"75100080107410","therapeutic_category":"MUSCULOSKELETAL THERAPY AGENTS (Medications to treat muscle pain)","therapeutic_class":"Central Muscle Relaxants","drug_name":"Orphenadrine Citrate ER Tablet Extended Release 12 Hour 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21403720100340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Selective Estrogen Receptor Degraders","drug_name":"Orserdu Tablet 345 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"345","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21403720100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Selective Estrogen Receptor Degraders","drug_name":"Orserdu Tablet 86 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"86","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"12504060200110","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Neuraminidase Inhibitors","drug_name":"Oseltamivir Phosphate Capsule 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12504060200115","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Neuraminidase Inhibitors","drug_name":"Oseltamivir Phosphate Capsule 45 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12504060200120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Neuraminidase Inhibitors","drug_name":"Oseltamivir Phosphate Capsule 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"10","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12504060201910","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Neuraminidase Inhibitors","drug_name":"Oseltamivir Phosphate Suspension Reconstituted 6 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"250","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"7320001010C320","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Osmolex ER Tablet ER 24 Hour Therapy Pack 129 & 193 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"129 & 193","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 24 Hour Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200010107520","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Osmolex ER Tablet Extended Release 24 Hour 129 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"129","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200010107530","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Osmolex ER Tablet Extended Release 24 Hour 193 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"193","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73200010107540","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Dopaminergics","drug_name":"Osmolex ER Tablet Extended Release 24 Hour 258 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Osmolex Extended Release","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"258","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66700015000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Phosphodiesterase 4 (PDE4) Inhibitors","drug_name":"Otezla Tablet 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66700015000330","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Phosphodiesterase 4 (PDE4) Inhibitors","drug_name":"Otezla Tablet 30 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OTEZLA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6670001500B720","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Phosphodiesterase 4 (PDE4) Inhibitors","drug_name":"Otezla Tablet Therapy Pack 10 & 20 & 30 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"OTEZLA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10 & 20 & 30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66700015007530","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Phosphodiesterase 4 (PDE4) Inhibitors","drug_name":"Otezla XR Tablet Extended Release 24 Hour 75 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6670001500B740","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Phosphodiesterase 4 (PDE4) Inhibitors","drug_name":"Otezla/Otezla XR Initiation Pk Tablet Therapy Pack 10&20&30&(ER)75 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10&20&30&(ER)75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01300050102115","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Oxacillin Sodium Solution Reconstituted 1 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01300050102131","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Oxacillin Sodium Solution Reconstituted 10 GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01300050102120","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillinase-Resistant Penicillins","drug_name":"Oxacillin Sodium Solution Reconstituted 2 GM Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"GM","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23200040000320","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Anabolic Steroids","drug_name":"Oxandrolone Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"23200040000305","therapeutic_category":"ANDROGENS-ANABOLIC (Medications to increase testosterone levels)","therapeutic_class":"Anabolic Steroids","drug_name":"Oxandrolone Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100065000320","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Oxaprozin Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82805080000320","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Hemoglobin S (HbS) Polymerization Inhibitors","drug_name":"Oxbryta Tablet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600046001820","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"OXcarbazepine Suspension 300 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600046000310","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"OXcarbazepine Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600046000320","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"OXcarbazepine Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600046000340","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"OXcarbazepine Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86770020202020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Nerve Growth Factors","drug_name":"Oxervate Solution 0.002 % Ophthalmic","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.002","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100045207530","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"Oxybutynin Chloride ER Tablet Extended Release 24 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100045207540","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"Oxybutynin Chloride ER Tablet Extended Release 24 Hour 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100045207520","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"Oxybutynin Chloride ER Tablet Extended Release 24 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100045202010","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"oxyBUTYnin Chloride Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100045201220","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"Oxybutynin Chloride SYRUP 5 MG/5ML ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100045200330","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"Oxybutynin Chloride Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"65100075100110","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"OxyCODONE HCl Capsule 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100075101320","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl Concentrate 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Concentrate","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A710","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl ER Tablet ER 12 Hour Abuse-Deterrent 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A715","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl ER Tablet ER 12 Hour Abuse-Deterrent 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A720","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl ER Tablet ER 12 Hour Abuse-Deterrent 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A730","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl ER Tablet ER 12 Hour Abuse-Deterrent 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A740","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl ER Tablet ER 12 Hour Abuse-Deterrent 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A760","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl ER Tablet ER 12 Hour Abuse-Deterrent 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100075102005","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100075100320","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100075100325","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100075100330","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100075100340","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100075100310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyCODONE HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65990002200335","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"oxyCODONE-Acetaminophen Tablet 10-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65990002200305","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"oxyCODONE-Acetaminophen Tablet 2.5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65990002200310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"oxyCODONE-Acetaminophen Tablet 5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65990002200327","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Combinations","drug_name":"oxyCODONE-Acetaminophen Tablet 7.5-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A710","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"OxyCONTIN Tablet ER 12 Hour Abuse-Deterrent 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A715","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"OxyCONTIN Tablet ER 12 Hour Abuse-Deterrent 15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A720","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"OxyCONTIN Tablet ER 12 Hour Abuse-Deterrent 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A730","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"OxyCONTIN Tablet ER 12 Hour Abuse-Deterrent 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A740","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"OxyCONTIN Tablet ER 12 Hour Abuse-Deterrent 40 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"6510007510A760","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"OxyCONTIN Tablet ER 12 Hour Abuse-Deterrent 60 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet ER 12 Hour Abuse-Deterrent","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080107410","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyMORphone HCl ER Tablet Extended Release 12 Hour 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080107415","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyMORphone HCl ER Tablet Extended Release 12 Hour 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080107420","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyMORphone HCl ER Tablet Extended Release 12 Hour 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080107430","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyMORphone HCl ER Tablet Extended Release 12 Hour 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080107405","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyMORphone HCl ER Tablet Extended Release 12 Hour 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080107407","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"oxyMORphone HCl ER Tablet Extended Release 12 Hour 7.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Long-Acting Opioids: Oxymorphone ER,Oxycodone ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080100310","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Oxymorphone HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"65100080100305","therapeutic_category":"ANALGESICS - OPIOID (Medications to treat pain that are narcotics)","therapeutic_class":"Opioid Agonists","drug_name":"Oxymorphone HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"79100070000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Oysco 500 Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oysco 500+D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100070000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Oyster Calcium Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium + D Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium + D3 Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100070000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Oyster Shell Calcium Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium w/D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902630330","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium/D Tablet 250-3.125 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-3.125","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640322","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium/D Tablet 250-6.25 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-6.25","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium/D Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902630345","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium/D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium/D3 Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902630330","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium/Vitamin D Tablet 250-3.125 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250-3.125","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Oyster Shell Calcium/Vitamin D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100070000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"Oystercal Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717007000D210","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Ozempic (0.25 or 0.5 MG/DOSE) Solution Pen-Injector 2 MG/1.5ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.50","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717007000D221","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Ozempic (0.25 or 0.5 MG/DOSE) Solution Pen-Injector 2 MG/3ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717007000D222","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Ozempic (1 MG/DOSE) Solution Pen-Injector 4 MG/3ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2717007000D225","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Incretin Mimetic Agents (GLP-1 Receptor Agonists)","drug_name":"Ozempic (2 MG/DOSE) Solution Pen-Injector 8 MG/3ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512060000310","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"PA Prenatal Formula Tablet 9-0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"9-0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35400005000303","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Pacerone Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35400005000305","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Pacerone Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35400005000320","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type III","drug_name":"Pacerone Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010002010","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain & Fever Childrens Solution 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain & Fever Childrens Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain & Fever Childrens Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain & Fever Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain & Fever Infants Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain & Fever Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain Relief 8 Hour Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain Relief Childrens Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain Relief Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain Relief Regular Strength Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain Reliever Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain Reliever Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010005205","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pain Reliever/Fever Reducer Suppository 120 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H535","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (12 MG Daily Dose) 2 x 1 MG & 10 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"45","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 1 MG &","strength_unit_of_measure":"10 MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H555","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (120 MG Daily Dose) 20 MG & 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20 MG &","strength_unit_of_measure":"100 MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H560","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (160 MG Daily Dose) 3 x 20 MG & 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3 x 20 MG &","strength_unit_of_measure":"100 MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H540","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (20 MG Daily Dose) 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"15","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H565","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (200 MG Daily Dose) 2 x 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 100","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H570","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (240 MG Daily Dose) 2 x 20 MG & 2 x 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 20 MG &","strength_unit_of_measure":"2 x 100 MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H525","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (3 MG Daily Dose) 3 x 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"45","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3 x 1","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"20100040203050","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (300 MG Maintenance) Packet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"20100040203030","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (300 MG Titration) Packet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"15","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H545","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (40 MG Daily Dose) 2 x 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 20","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H530","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (6 MG Daily Dose) 6 x 1 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6 x 1","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H550","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia (80 MG Daily Dose) 4 x 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4 x 20","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2010004020H510","therapeutic_category":"ALLERGENIC EXTRACTS/BIOLOGICALS MISC(Medications used for enzyme replacement)","therapeutic_class":"Allergenic Extracts","drug_name":"Palforzia Initial Escalation 0.5 & 1 & 1.5 & 3 & 6 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"13","quantity_limit_days":"14"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5 & 1 & 1.5 &","strength_unit_of_measure":"3 & 6 MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3090855040E520","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Palynziq Solution Prefilled Syringe 10 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3090855040E510","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Palynziq Solution Prefilled Syringe 2.5 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3090855040E530","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Palynziq Solution Prefilled Syringe 20 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Pamprin All Day Relief Max St Tablet 220 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270070100610","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Pantoprazole Sodium Tablet Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"49270070100620","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"Pantoprazole Sodium Tablet Delayed Release 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25050010005320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Copper Contraceptives - IUD","drug_name":"Paragard Intrauterine Copper Intrauterine Device Intrauterine","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intrauterine","dose_form":"Intrauterine Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905070000110","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Paricalcitol Capsule 1 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905070000120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Paricalcitol Capsule 2 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905070000140","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Paricalcitol Capsule 4 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"07000055100110","therapeutic_category":"AMINOGLYCOSIDES (Medications to treat certain types of bacterial infection)","therapeutic_class":"Aminoglycosides","drug_name":"Paromomycin Sulfate Capsule 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"168","quantity_limit_days":"21"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1299000255B710","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiviral Combinations","drug_name":"Paxlovid (150/100) Tablet Therapy Pack 10 x 150 MG & 10 x 100MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10 x 150 MG &","strength_unit_of_measure":"10 x 100MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1299000255B705","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiviral Combinations","drug_name":"Paxlovid (300/100 & 150/100) Tablet Therapy Pack 6 x 150 MG & 5 x 100MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6 x 150 MG &","strength_unit_of_measure":"5 x 100MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1299000255B720","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiviral Combinations","drug_name":"Paxlovid (300/100) Tablet Therapy Pack 20 x 150 MG & 10 x 100MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20 x 150 MG &","strength_unit_of_measure":"10 x 100MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533042100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"PAZOPanib HCl Tablet 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"97101530006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Peak Flow Meters","drug_name":"Peak Air Peak Flow Meter Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"PediaCare Children Suspension 160 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"PediaCare Infants Gas Relief Suspension 20 MG/0.3ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/0.3ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"PediaCare Infants Suspension 160 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79991000002000","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Electrolytes Oral","drug_name":"Pedialyte Solution Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6000","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 10 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Solution","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1899000550E620","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Pediarix Suspension Prefilled Syringe Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"PediaSure 1.0 Cal/Fiber Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"PediaSure Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17200030101820","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Pedvax HIB Suspension 7.5 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"PEG 3350 Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46992005302140","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bowel Evacuant Combinations","drug_name":"PEG 3350/Electrolytes Solution Reconstituted 240 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46992004302120","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bowel Evacuant Combinations","drug_name":"PEG 3350-KCl-Na Bicarb-NaCl Solution Reconstituted 420 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"420","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46992005302130","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Bowel Evacuant Combinations","drug_name":"PEG-3350/Electrolytes Solution Reconstituted 236 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"236","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12353060052030","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Pegasys ProClick Solution 135 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PEGASYS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"135","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12353060052040","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Pegasys ProClick Solution 180 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PEGASYS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1235306005D530","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Pegasys ProClick Solution Auto-Injector 135 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PEGASYS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"135","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1235306005D540","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Pegasys ProClick Solution Auto-Injector 180 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PEGASYS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12353060052040","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Pegasys SOLUTION 180 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PEGASYS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12353060052020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Pegasys Solution 180 MCG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PEGASYS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MCG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1235306005E540","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Pegasys Solution Prefilled Syringe 180 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PEGASYS"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532260000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Pemazyre Tablet 13.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"13.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532260000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Pemazyre Tablet 4.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21532260000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - FGFR Kinase Inhibitors","drug_name":"Pemazyre Tablet 9 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Pen Needles 5/16\" 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17200040601900","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Penbraya Suspension Reconstituted Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99200030000110","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Chelating Agents","drug_name":"penicillAMINE Capsule 250 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99200030000305","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Chelating Agents","drug_name":"penicillAMINE Tablet 250 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01100010202105","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Penicillin G Sodium SOLUTION RECONSTITUTED 5000000 UNIT INJECTION","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5000000","strength_unit_of_measure":"UNIT","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01100040102105","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Penicillin V Potassium Solution Reconstituted 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01100040102110","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Penicillin V Potassium Solution Reconstituted 250 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01100040100310","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Penicillin V Potassium Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01100040100315","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Natural Penicillins","drug_name":"Penicillin V Potassium Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990005301920","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Pentacel Suspension Reconstituted Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16000045002170","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Anti-infective Agents - Misc.","drug_name":"Pentamidine Isethionate Solution Reconstituted 300 MG Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Inhalation","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85200010000410","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Hematorheologic Agents","drug_name":"Pentoxifylline ER Tablet Extended Release 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Peptamen 1.5 Cal Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Peptamen AF Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Peptamen Junior 1 Cal Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Peptamen Junior 1.5 Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Peptamen Junior Fiber Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200315","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Perdiem Overnight Relief Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100035100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Perindopril Erbumine Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100035100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Perindopril Erbumine Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100035100330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Perindopril Erbumine Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90900035003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"Permethrin Cream 5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pharbetol Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"Pharbetol Tablet 325 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Pharmacist Choice Alcohol Pad","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Phazyme Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060001010","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Elixir 20 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Elixir","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060001010","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Elixir 30 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Elixir","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060001010","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Elixir 60 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Elixir","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000325","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000305","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000308","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 16.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"16.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000315","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000317","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 32.4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32.4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000320","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000322","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 64.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"64.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60100060000324","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Barbiturate Hypnotics","drug_name":"PHENobarbital Tablet 97.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"97.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36300010100105","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Agents for Pheochromocytoma","drug_name":"Phenoxybenzamine HCl Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61209902307040","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Anorexiant Combinations","drug_name":"Phentermine-Topiramate ER Capsule Extended Release 24 Hour 11.25-69 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"11.25-69","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61209902307050","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Anorexiant Combinations","drug_name":"Phentermine-Topiramate ER Capsule Extended Release 24 Hour 15-92 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15-92","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61209902307020","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Anorexiant Combinations","drug_name":"Phentermine-Topiramate ER Capsule Extended Release 24 Hour 3.75-23 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.75-23","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"61209902307030","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Anorexiant Combinations","drug_name":"Phentermine-Topiramate ER Capsule Extended Release 24 Hour 7.5-46 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7.5-46","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72200030000505","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Phenytoin Infatabs Tablet Chewable 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72200030200110","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Phenytoin Sodium Extended Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72200030200120","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Phenytoin Sodium Extended CAPSULE 200 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72200030200130","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Phenytoin Sodium Extended CAPSULE 300 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72200030001810","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Phenytoin Suspension 100 MG/4ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/4ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72200030001810","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Phenytoin Suspension 125 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72200030000505","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Hydantoins","drug_name":"Phenytoin Tablet Chewable 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"55329903404020","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Vaginal Contraceptive pH Modulator - Combinations","drug_name":"Phexxi Gel 1.8-1-0.4 % Vaginal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.8-1-0.4","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Gel","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52800020102020","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Phosphate Binder Agents","drug_name":"Phoslyra Solution 667 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"667","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79600030100320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Phosphate","drug_name":"Phosphorous Tablet 155-852-130 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"155-852-130","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77204030000305","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin K","drug_name":"Phytonadione Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"5","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12109025000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Pifeltro Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86501030102015","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Miotics - Direct Acting","drug_name":"Pilocarpine HCl Solution 1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86501030102020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Miotics - Direct Acting","drug_name":"Pilocarpine HCl Solution 2 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86501030102030","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Miotics - Direct Acting","drug_name":"Pilocarpine HCl Solution 4 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90784060003720","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Macrolide Immunosuppressants - Topical","drug_name":"Pimecrolimus Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25991002050320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Biphasic Contraceptives - Oral","drug_name":"Pimtrea TABLET 0.15-0.02/0.01 MG (21/5) ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-0.02/0.01","strength_unit_of_measure":"MG (21/5)","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33100030000310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Pindolol Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100030000305","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Pindolol Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47300010001830","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Pink Bismuth Maximum Strength Suspension 525 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"525","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000060101805","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Pinworm Medicine Suspension 144 (50 Base) MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"144 (50 Base)","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27607050100320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Thiazolidinediones","drug_name":"Pioglitazone HCl Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27607050100330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Thiazolidinediones","drug_name":"Pioglitazone HCl Tablet 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27607050100340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Thiazolidinediones","drug_name":"Pioglitazone HCl Tablet 45 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"01990002702120","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Piperacillin Sod-Tazobactam So Solution Reconstituted 2.25 (2-0.25) GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.25 (2-0.25)","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002702130","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Piperacillin Sod-Tazobactam So Solution Reconstituted 3.375 (3-0.375) GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.375 (3-0.375)","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002702140","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Piperacillin Sod-Tazobactam So Solution Reconstituted 4.5 (4-0.5) GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4.5 (4-0.5)","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"01990002702170","therapeutic_category":"PENICILLINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Penicillin Combinations","drug_name":"Piperacillin Sod-Tazobactam So Solution Reconstituted 40.5 (36-4.5) GM Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40.5 (36-4.5)","strength_unit_of_measure":"GM","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153801000B720","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Phosphatidylinositol 3-Kinase (PI3K) Inhibitors","drug_name":"Piqray (200 MG Daily Dose) Tablet Therapy Pack 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153801000B725","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Phosphatidylinositol 3-Kinase (PI3K) Inhibitors","drug_name":"Piqray (250 MG Daily Dose) Tablet Therapy Pack 200 & 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200 & 50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2153801000B730","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Phosphatidylinositol 3-Kinase (PI3K) Inhibitors","drug_name":"Piqray (300 MG Daily Dose) Tablet Therapy Pack 2 x 150 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2 x 150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45550060000120","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Pulmonary Fibrosis Agents","drug_name":"Pirfenidone Capsule 267 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"267","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45550060000325","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Pulmonary Fibrosis Agents","drug_name":"Pirfenidone Tablet 267 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"267","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"45550060000345","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Pulmonary Fibrosis Agents","drug_name":"Pirfenidone Tablet 801 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"801","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002500320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Pirmella 1/35 Tablet 1-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100070000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Piroxicam Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100070000110","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"Piroxicam Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Celecoxib, Mefenamic Acid","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39400058100321","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Pitavastatin Calcium Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400058100331","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Pitavastatin Calcium Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400058100341","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Pitavastatin Calcium Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"6240307530D520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Plegridy Solution Auto-Injector 125 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Plegridy"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240307530D220","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Plegridy Solution Pen-Injector 125 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Plegridy"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240307530E520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Plegridy Solution Prefilled Syringe 125 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Plegridy"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"125","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240307530D550","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Plegridy Starter Pack Solution Auto-Injector 63 & 94 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Plegridy"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"63 & 94","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240307530D250","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Plegridy Starter Pack Solution Pen-injector 63 & 94 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Plegridy"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"63 & 94","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240307530E550","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Plegridy Starter Pack Solution Prefilled Syringe 63 & 94 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Plegridy"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"63 & 94","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82502060002020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"CXCR4 Receptor Antagonist","drug_name":"Plerixafor Solution 24 MG/1.2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"24","strength_unit_of_measure":"MG/1.2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200065002205","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Pneumovax 23 Injectable 25 MCG/0.5ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200065002010","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Pneumovax 23 Solution 25 MCG/0.5ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1720006500E510","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Pneumovax 23 Solution Prefilled Syringe 25 MCG/0.5ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512015000324","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"PNV Folic Acid + Iron Tablet 27-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78516040006327","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"PNV OB+DHA 27-1 & 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1 & 250","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000324","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"PNV Prenatal Plus Multivitamin Tablet 27-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78516024000125","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"PNV-DHA CAPSULE 27-0.6-0.4-300 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.6-0.4-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78516037000138","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"PNV-DHA+Docusate Capsule 27-1.25-300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1.25-300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512062000130","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"PNV-Omega CAPSULE 28-0.6-0.4-340 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.6-0.4-340","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512022000320","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"PNV-Select Tablet 27-0.6-0.4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.6-0.4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512095000130","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"PNV-Total Capsule 35-5-1.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"35-5-1.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"Pocket Chamber Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"Pocket Spacer Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90750015002020","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Keratolytic/Antimitotic/Vesicant Agents","drug_name":"Podofilox Solution 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051020186320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Poly Hub Needle 18G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"18G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051020216320","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Poly Hub Needle 21G X 1\"","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21G X 1\"","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"Polyethylene Glycol 3350 Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86109902602020","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Anti-infective Combinations","drug_name":"Polymyxin B-Trimethoprim Solution 10000-0.1 UNIT/ML-% Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10000-0.1","strength_unit_of_measure":"UNIT/ML-%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"96200082002000","therapeutic_category":"CHEMICALS (Miscellaneous liquid therapeutic agents)","therapeutic_class":"Liquids","drug_name":"Polysorbate 40 SOLUTION","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78441000001810","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Poly-Vi-Flor Suspension 0.25 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000000505","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Poly-Vi-Flor Tablet Chewable 0.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000000510","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Poly-Vi-Flor Tablet Chewable 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78441000000520","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Fluoride","drug_name":"Poly-Vi-Flor Tablet Chewable 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78450000001810","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multi Vitamins w/Fl & FE","drug_name":"Poly-Vi-Flor/Iron Suspension 0.25-7 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-7","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78450000000518","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multi Vitamins w/Fl & FE","drug_name":"Poly-Vi-Flor/Iron Tablet Chewable 0.5-10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5-10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78410000002000","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Pediatric Multiple Vitamins","drug_name":"Poly-Vi-Sol Solution Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000002012","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"Poly-Vi-Sol/Iron Solution 11 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"11","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78430000002010","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"Poly-Vitamin/Iron Solution 10 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78421000000530","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped Multiple Vitamins w/ Minerals & C","drug_name":"Polyvitamin/Iron Tablet Chewable Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21450080000110","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Immunomodulators","drug_name":"Pomalyst CAPSULE 1 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Pomalyst"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21450080000115","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Immunomodulators","drug_name":"Pomalyst CAPSULE 2 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Pomalyst"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21450080000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Immunomodulators","drug_name":"Pomalyst CAPSULE 3 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Pomalyst"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21450080000125","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Immunomodulators","drug_name":"Pomalyst CAPSULE 4 MG ORAL","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Pomalyst"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240706000B720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Ponvory Starter Pack Tablet Therapy Pack 2-3-4-5-6-7-8-9 & 10 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2-3-4-5-6-7-8-9","strength_unit_of_measure":"& 10 MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62407060000320","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Sphingosine 1-Phosphate (S1P) Receptor Modulators","drug_name":"Ponvory Tablet 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Portia-28 TABLET 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407060001820","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Posaconazole Suspension 40 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"11407060000620","therapeutic_category":"ANTIFUNGALS (Medications to treat certain types of fungal infections)","therapeutic_class":"Triazoles","drug_name":"Posaconazole Tablet Delayed Release 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79700020000810","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Bicarbonate Tablet Effervescent 25 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Effervescent","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030100430","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride Crys ER Tablet Extended Release 10 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030100440","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride Crys ER Tablet Extended Release 20 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000210","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride ER Capsule Extended Release 10 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000205","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride ER Capsule Extended Release 8 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000430","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride ER Tablet Extended Release 10 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000445","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride ER Tablet Extended Release 20 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030000420","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride ER Tablet Extended Release 8 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700030002085","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Chloride Solution 20 MEQ/15ML (10%) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20 MEQ/15ML","strength_unit_of_measure":"(10%)","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56202010200440","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Citrates","drug_name":"Potassium Citrate ER Tablet Extended Release 10 MEQ (1080 MG) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10 MEQ","strength_unit_of_measure":"(1080 MG)","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56202010200460","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Citrates","drug_name":"Potassium Citrate ER Tablet Extended Release 15 MEQ (1620 MG) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15 MEQ","strength_unit_of_measure":"(1620 MG)","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56202010200420","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Citrates","drug_name":"Potassium Citrate ER Tablet Extended Release 5 MEQ (540 MG) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5 MEQ","strength_unit_of_measure":"(540 MG)","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56202022002025","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Citrates","drug_name":"Potassium Citrate-Citric Acid Solution 1100-334 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1100-334","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79700050000311","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"Potassium Gluconate Tablet 2.5 MEQ Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MEQ","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79600010052030","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Phosphate","drug_name":"Potassium Phosphates Solution 45 MMOLE/15ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MMOLE/15ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79600010052030","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Phosphate","drug_name":"Potassium Phosphates(66 mEq K) Solution 45 MMOLE/15ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MMOLE/15ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3935001000D530","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"PCSK9 Inhibitors","drug_name":"Praluent Solution Auto-Injector 150 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3935001000D520","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"PCSK9 Inhibitors","drug_name":"Praluent Solution Auto-Injector 75 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060107520","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride ER Tablet Extended Release 24 Hour 0.375 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.375","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060107530","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride ER Tablet Extended Release 24 Hour 0.75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060107540","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride ER Tablet Extended Release 24 Hour 1.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060107545","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride ER Tablet Extended Release 24 Hour 2.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060107550","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride ER Tablet Extended Release 24 Hour 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060107555","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride ER Tablet Extended Release 24 Hour 3.75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060107560","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride ER Tablet Extended Release 24 Hour 4.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060100305","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride Tablet 0.125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060100310","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride Tablet 0.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060100315","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060100317","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride Tablet 0.75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060100320","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203060100330","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"Pramipexole Dihydrochloride Tablet 1.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85158060100330","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Thienopyridine Derivatives","drug_name":"Prasugrel HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85158060100320","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Thienopyridine Derivatives","drug_name":"Prasugrel HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39400065100320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Pravastatin Sodium Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400065100330","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Pravastatin Sodium Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400065100340","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Pravastatin Sodium Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400065100360","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Pravastatin Sodium Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"15000050000305","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Praziquantel Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36202030100105","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Peripherally Acting","drug_name":"Prazosin HCl Capsule 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36202030100110","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Peripherally Acting","drug_name":"Prazosin HCl Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36202030100115","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"Antiadrenergics - Peripherally Acting","drug_name":"Prazosin HCl Capsule 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86300050101815","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroids","drug_name":"prednisoLONE Acetate Suspension 1 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86300050202015","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Steroids","drug_name":"PrednisoLONE Sodium Phosphate Solution 1 % Ophthalmic","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040202050","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"PrednisoLONE Sodium Phosphate Solution 10 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040202020","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"prednisoLONE Sodium Phosphate Solution 15 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040202060","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"PrednisoLONE Sodium Phosphate Solution 20 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040202025","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"prednisoLONE Sodium Phosphate Solution 25 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040202040","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"prednisoLONE Sodium Phosphate Solution 5 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040002020","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"prednisoLONE Solution 15 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100040001205","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"prednisoLONE Syrup 15 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045001310","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"PredniSONE Intensol Concentrate 5 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Concentrate","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045002005","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"PredniSONE SOLUTION 5 MG/5ML ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045000305","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045000320","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045000310","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045000325","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045000315","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100045000335","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2210004500B720","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet Therapy Pack 10 MG (21) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG (21)","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2210004500B705","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"predniSONE Tablet Therapy Pack 5 MG (21) Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG (21)","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600057000125","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600057000135","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600057000145","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600057000150","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 225 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"225","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600057000110","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600057000160","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600057000115","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600057000120","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Pregabalin Capsule 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17100010401820","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"PreHevbrio Suspension 10 MCG/ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002040370","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Premphase Tablet 0.625-5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.625-5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002040340","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Prempro Tablet 0.3-1.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.3-1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002040345","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Prempro Tablet 0.45-1.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.45-1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002040350","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Prempro Tablet 0.625-2.5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.625-2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"24993002040360","therapeutic_category":"ESTROGENS (Medications to supplement estrogen hormones)","therapeutic_class":"Estrogen & Progestin","drug_name":"Prempro Tablet 0.625-5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.625-5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78516037000170","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"Prenaissance Capsule 29-1.25-325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1.25-325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512097006331","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenaissance Harmony DHA 27-1 & 380 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1 & 380","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78510025000320","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal Vitamins","drug_name":"Prenaissance Next Tablet 1.2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78510025000321","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal Vitamins","drug_name":"Prenaissance Next-B Tablet 1.22 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.22","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78516035000130","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"Prenaissance Plus Capsule 28-1-250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-1-250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512000000315","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal (w/Iron & FA) Tablet 27-0.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512070000330","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal 19 Tablet 29-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000530","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal 19 Tablet Chewable 29-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000530","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal 19 TABLET CHEWABLE ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply via mail order","protected_class":false,"emergency_fill":false},{"gpi":"78512070000330","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal 19 Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000306","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Complete Tablet 14-0.4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14-0.4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512050000310","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Formula A-Free Tablet 9-0.267 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"9-0.267","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512018000115","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Formula Capsule 28-0.8-235 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.8-235","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512000000315","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Pre-Natal Formula Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512000000315","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Forte Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000322","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Low Iron Tablet 27-0.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000324","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Low Iron Tablet 27-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512018000109","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Multi +DHA Capsule 27-0.8-228 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.8-228","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000322","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal One Daily Tablet 27-0.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512010000330","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Plus Iron Tablet 29-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000324","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Plus Tablet 27-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000322","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Tablet 27-0.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000324","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Tablet 27-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000328","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal Tablet 28-0.8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512000000315","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal/Iron Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512021000130","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Prenatal/Omega-3/FA/Iron Capsule 28-0.8-530 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.8-530","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78516020006318","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA-DHA","drug_name":"Prenatal+DHA 28-0.975 & 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.975 & 200","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"09000063000320","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Pretomanid Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002950310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Previfem Tablet 0.25-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17200065301800","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Prevnar 13 Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1720006540E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Bacterial Vaccines","drug_name":"Prevnar 20 Suspension Prefilled Syringe 0.5 ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12200045003040","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"CMV Agents","drug_name":"Prevymis Packet 120 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"1"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12200045003020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"CMV Agents","drug_name":"Prevymis Packet 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"1"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12200045000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"CMV Agents","drug_name":"Prevymis Tablet 240 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"1"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12200045000340","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"CMV Agents","drug_name":"Prevymis Tablet 480 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"1"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"480","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902270315","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Prezcobix Tablet 675-150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"675-150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109902270320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretroviral Combinations","drug_name":"Prezcobix Tablet 800-150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"800-150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104520001820","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Prezista Suspension 100 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104520000310","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Prezista Tablet 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104520000305","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Prezista Tablet 75 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13000030100310","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarials","drug_name":"Primaquine Phosphate Tablet 26.3 (15 Base) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"26.3 (15 Base)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600060000307","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Primidone Tablet 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600060000310","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Primidone Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"72600060000305","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Primidone Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17109903101901","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccine Combinations","drug_name":"Priorix Suspension Reconstituted Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Subcutaneous","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"68100010000310","therapeutic_category":"GOUT AGENTS (Medications to treat gout)","therapeutic_class":"Uricosurics","drug_name":"Probenecid Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"FEBUXOSTAT","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Probiata Tablet Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300020000100","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Probiotic (Lactobacillus) Capsule Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300020000300","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Probiotic Acidophilus Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300025000100","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Probiotic Capsule Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300025000100","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Probiotic Product Capsule Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35100020102900","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-A","drug_name":"Procainamide HCl POWDER","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"ProChamber VHC Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"59200055100310","therapeutic_category":"ANTIPSYCHOTICS/ANTIMANIC AGENTS (Medications to treat mental health disorders)","therapeutic_class":"Phenothiazines","drug_name":"Prochlorperazine Maleate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"59200055100305","therapeutic_category":"ANTIPSYCHOTICS/ANTIMANIC AGENTS (Medications to treat mental health disorders)","therapeutic_class":"Phenothiazines","drug_name":"Prochlorperazine Maleate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"59200055005215","therapeutic_category":"ANTIPSYCHOTICS/ANTIMANIC AGENTS (Medications to treat mental health disorders)","therapeutic_class":"Phenothiazines","drug_name":"Prochlorperazine Suppository 25 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002040","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Procrit Solution 10000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002010","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Procrit Solution 2000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002050","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Procrit Solution 20000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002015","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Procrit Solution 3000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Procrit Solution 4000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020002060","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Procrit SOLUTION 40000 UNIT/ML INJECTION","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56400030106520","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Cystinosis Agents","drug_name":"Procysbi Capsule Delayed Release 25 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56400030106530","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Cystinosis Agents","drug_name":"Procysbi Capsule Delayed Release 75 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56400030103040","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Cystinosis Agents","drug_name":"Procysbi Packet 300 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56400030103020","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Cystinosis Agents","drug_name":"Procysbi Packet 75 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051030906318","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"Prodigy Insulin Syringe 31G X 5/16\" 0.5 ML","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5/16\"","strength_unit_of_measure":"0.5 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"26000040000120","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"Progesterone Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000040000140","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"Progesterone Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000040100120","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"Progesterone Micronized Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Hormone Replacement Therapy (HRT): Menest, Premphase, Prempro","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000040100130","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"Progesterone Micronized Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"26000040001705","therapeutic_category":"PROGESTINS (Medications to supplement progesterone hormones)","therapeutic_class":"Progestins","drug_name":"Progesterone Oil 50 MG/ML Intramuscular","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/ML","route":"Intramuscular","dose_form":"Oil","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30044530002020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"RANK Ligand (RANKL) Inhibitors","drug_name":"Prolia SOLUTION 60 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"PROLIA"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030103030","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Promacta Packet 12.5 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82405030103020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Thrombopoietin (TPO) Receptor Agonists","drug_name":"Promacta Packet 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41400020102060","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Phenothiazines","drug_name":"Promethazine HCl Solution 6.25 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6.25","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41400020105205","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Phenothiazines","drug_name":"Promethazine HCl Suppository 12.5 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41400020105210","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Phenothiazines","drug_name":"Promethazine HCl Suppository 25 MG Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Rectal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41400020101210","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Phenothiazines","drug_name":"Promethazine HCl Syrup 6.25 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6.25","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41400020100305","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Phenothiazines","drug_name":"Promethazine HCl Tablet 12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41400020100310","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Phenothiazines","drug_name":"Promethazine HCl Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"41400020100315","therapeutic_category":"ANTIHISTAMINES (Medications to treat allergies or allergic reactions)","therapeutic_class":"Antihistamines - Phenothiazines","drug_name":"Promethazine HCl Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640357","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"Pronutrients Calcium+D3 Tablet 600-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"35300050006920","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Propafenone HCl ER Capsule Extended Release 12 Hour 225 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"225","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35300050006930","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Propafenone HCl ER Capsule Extended Release 12 Hour 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35300050006940","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Propafenone HCl ER Capsule Extended Release 12 Hour 425 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"425","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35300050000320","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Propafenone HCl Tablet 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35300050000325","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Propafenone HCl Tablet 225 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"225","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35300050000330","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-C","drug_name":"Propafenone HCl Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"86750020102005","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Local Anesthetics","drug_name":"Proparacaine HCl Solution 0.5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33100040107035","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl ER Capsule Extended Release 24 Hour 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040107040","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl ER Capsule Extended Release 24 Hour 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040107025","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl ER Capsule Extended Release 24 Hour 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040107030","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl ER Capsule Extended Release 24 Hour 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040102050","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl Solution 20 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040102060","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl Solution 40 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040100305","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040100310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040100315","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040100320","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl Tablet 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100040100325","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Propranolol HCl Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"28300020000310","therapeutic_category":"THYROID AGENTS (Medications to treat thyroid disorders)","therapeutic_class":"Antithyroid Agents","drug_name":"Propylthiouracil Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17109904202200","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccine Combinations","drug_name":"ProQuad Injectable Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Subcutaneous","dose_form":"Injectable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"80301010000900","therapeutic_category":"NUTRIENTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Protein Products","drug_name":"ProSource No Carb Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44400015008018","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Pulmicort Flexhaler Aerosol Powder Breath Activated 180 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400015008009","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Pulmicort Flexhaler Aerosol Powder Breath Activated 90 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"90","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"M","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Pulmocare Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"45304020002010","therapeutic_category":"RESPIRATORY AGENTS - MISC. (Medications to treat pulmonary disorders)","therapeutic_class":"Hydrolytic Enzymes","drug_name":"Pulmozyme Solution 2.5 MG/2.5ML Inhalation","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG/2.5ML","route":"Inhalation","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Puramino DHA/ARA Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512058000160","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"PureFe OB Plus Capsule 162-115.2-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"162-115.2-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"PX Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"PX Antacid Maximum Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"PX Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"PX Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"PX Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"PX Aspirin Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"PX Calcium Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"PX Extra Short Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"PX Gas Relief Extra Strength Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"PX Gas Relief Ultra Strength Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106410","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"PX Miconazole 3-Day Combo Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"PX Pain Relief Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"PX Pen Needle 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"PX Pen Needle 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"PX Stop Smoking Aid Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"PX Stop Smoking Aid Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"PX Stop Smoking Aid Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000070000310","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Pyrazinamide Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"76000050100305","therapeutic_category":"ANTIMYASTHENIC/CHOLINERGIC AGENTS (Medications to treat certain neuromuscular conditions)","therapeutic_class":"Antimyasthenic/Cholinergic Agents","drug_name":"pyRIDostigmine Bromide Tablet 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"13000040000310","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarials","drug_name":"Pyrimethamine Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85870050700325","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Pyruvate Kinase Activators","drug_name":"Pyrukynd Tablet 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85870050700310","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Pyruvate Kinase Activators","drug_name":"Pyrukynd Tablet 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"85870050700340","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Pyruvate Kinase Activators","drug_name":"Pyrukynd Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"56","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8587005070B710","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Pyruvate Kinase Activators","drug_name":"Pyrukynd Taper Pack Tablet Therapy Pack 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8587005070B720","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Pyruvate Kinase Activators","drug_name":"Pyrukynd Taper Pack Tablet Therapy Pack 7 x 20 MG & 7 x 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7 x 20 MG &","strength_unit_of_measure":"7 x 5 MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8587005070B735","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Pyruvate Kinase Activators","drug_name":"Pyrukynd Taper Pack Tablet Therapy Pack 7 x 50 MG & 7 x 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"28","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7 x 50 MG &","strength_unit_of_measure":"7 x 20 MG","route":"Oral","dose_form":"Tablet Therapy Pack","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103720","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"QC 3 Day Cream 4 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"QC Alcohol Swabs Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"QC Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"QC Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"QC Anti-Gas Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"QC Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"QC Aspirin Low Dose Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"QC Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"QC Aspirin Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"QC Bacitracin Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"QC Childrens Aspirin Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78430000000515","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Ped MV w/ Iron","drug_name":"QC Childrens Vitamins/Iron Tablet Chewable 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64109902110820","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylate Combinations","drug_name":"QC Effervescent Antacid/Pain Tablet Effervescent 325-1000-1916 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325-1000-1916","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Effervescent","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"QC Enema Enema 16-6 GM/133ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"16-6","strength_unit_of_measure":"GM/133ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"QC Gas Relief Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"QC Gas Relief Extra Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"QC Gentle Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002150520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"QC Heartburn Antacid Tablet Chewable 160-105 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160-105","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"QC Miconazole 7 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"QC Naproxen Sodium Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"QC Non-Aspirin 8 Hour Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"QC Non-Aspirin Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"QC Non-Aspirin Jr Strength Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270060106520","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"QC Omeprazole Magnesium Capsule Delayed Release 20.6 (20 Base) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20.6 (20 Base)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"QC Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"QC Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"QC Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47300010001805","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"QC Pink Bismuth Suspension 262 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"QC Senna Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"QC Unifine Pentips 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21533053000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Qinlock Tablet 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"18990004351820","therapeutic_category":"TOXOIDS (Vaccines to prevent certain viral infections)","therapeutic_class":"Toxoid Combinations","drug_name":"Quadracel Suspension Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300350","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Quartette Tablet 42-21-21-7 DAYS Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"42-21-21-7","strength_unit_of_measure":"DAYS","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25993002300320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Extended-Cycle Contraceptives - Oral","drug_name":"Quasense Tablet 0.15-0.03 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-0.03","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"94101024356400","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Infection Tests","drug_name":"QuickVue At-Home Covid-19 Test Kit In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100040100310","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Quinapril HCl Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100040100320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Quinapril HCl Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100040100340","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Quinapril HCl Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100040100305","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Quinapril HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802650320","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Quinapril-hydroCHLOROthiazide Tablet 10-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802650330","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Quinapril-hydroCHLOROthiazide Tablet 20-12.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-12.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36991802650335","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors & Thiazide/Thiazide-Like","drug_name":"Quinapril-hydroCHLOROthiazide Tablet 20-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35100030300310","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-A","drug_name":"quiNIDine Sulfate Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"35100030300315","therapeutic_category":"ANTIARRHYTHMICS (Medications to help control heart rate)","therapeutic_class":"Antiarrhythmics Type I-A","drug_name":"quiNIDine Sulfate Tablet 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"13000060100119","therapeutic_category":"ANTIMALARIALS (Medications to treat malaria)","therapeutic_class":"Antimalarials","drug_name":"QuiNINE Sulfate Capsule 324 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"42","quantity_limit_days":"90"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"324","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44400010103408","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Qvar Aerosol Solution 40 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400010103428","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Qvar Aerosol Solution 80 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400010128120","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Qvar RediHaler Aerosol Breath Activated 40 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21.20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44400010128140","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Steroid Inhalants","drug_name":"Qvar RediHaler Aerosol Breath Activated 80 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"21.20","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Breath Activated","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA 8 Hour Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA Acetaminophen Ex St Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA Acetaminophen Rapid Melts Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007210","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA Acetaminophen Rapid Melts Tablet Dispersible 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA Acetaminophen Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA Acetaminophen Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"RA Alcohol Swabs Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"RA Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"RA Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"RA Antacid Ultra Strength Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100105","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"RA Anti-Diarrheal Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100905","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"RA Anti-Diarrheal Liquid 1 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"RA Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"RA Anti-Itch Maximum Strength Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin Adult Low Dose Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin Adult Low Strength Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin Childrens Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin EC Adult Low St Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin EC Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin EC Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000330","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"RA Aspirin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010104210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"RA Bacitracin Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97750010006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Blood Pressure Devices","drug_name":"RA Blood Pressure Cuff Monitor","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97750010006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Blood Pressure Devices","drug_name":"RA Blood Pressure Cuff Monitor Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"RA Calcium 600 Tablet 1500 (600 Ca) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1500 (600 Ca)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100007000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"RA Calcium 600 TABLET 600 MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"RA Calcium 600/Vitamin D-3 Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100005000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"RA Calcium Hi-Cal Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100005000325","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"RA Calcium High Potency Tablet 600 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"RA Calcium Plus Vitamin D Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"RA Calcium Plus Vitamin D Tablet 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"RA Calcium Plus Vitamin D3 Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100005000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"RA Calcium Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104020003705","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"RA Clotrimazole 7 Cream 1 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"RA Enema Enema 7-19 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7-19","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"RA Fever Reducer/Pain Reliever Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"RA Gas Relief Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"RA Gas Relief Extra Strength Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"RA Gas Relief Extra Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"RA Gas Relief Maximum Strength Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"RA Gas Relief Ultra Strength Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030004020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"RA Glucose Gel 40 % Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"%","route":"Oral","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"RA Hi Cal Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100070000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"RA Hi-Cal Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000105","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"RA Ibuprofen Capsule 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001820","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"RA Ibuprofen Childrens Suspension 100 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"RA Ibuprofen Infants Suspension 50 MG/1.25ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/1.25ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020000520","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"RA Ibuprofen Junior Strength Tablet Chewable 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82300010000303","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Iron","drug_name":"RA Iron Tablet 27 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"27","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90971501406320","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Skin Cleansers","drug_name":"RA Isopropyl Alcohol Wipes 70 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":"External","dose_form":null,"multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"RA Laxative Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"RA Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"80303020200340","therapeutic_category":"NUTRIENTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Amino Acids-Single","drug_name":"RA L-Lysine Tablet 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"RA Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106464","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"RA Miconazole 3 Combo Pack App Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106410","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"RA Miconazole 3 Combo Pack Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"RA Miconazole 7 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Mini Nicotine Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Mini Nicotine Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"RA Motion Sickness Relief Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"RA Motion Sickness Relief Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000510","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"RA Motion Sickness Relief Tablet Chewable 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"RA Naproxen Sodium Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77103010000330","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"RA Niacin Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77103010000350","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"RA Niacin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002820","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Gum 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Patch 24 Hour 14 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Patch 24 Hour 21 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Polacrilex Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"RA Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"RA Night Sleep Aid Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77103010000350","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-3","drug_name":"RA No Flush Niacin Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79100070000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"RA Oyster Shell Calcium Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146358","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"RA Pen Needles 31G X 5 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 5 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"RA Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47300010000307","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"RA Pink Bismuth Tablet 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"RA Saline Enema Enema 19-7 GM/118ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"19-7","strength_unit_of_measure":"GM/118ML","route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"RA Sleep Aid Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000504","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"RA Stomach Relief Kids Tablet Chewable 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"RA Womens Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49270076100620","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"Proton Pump Inhibitors","drug_name":"RABEprazole Sodium Tablet Delayed Release 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"74509030001820","therapeutic_category":"NEUROMUSCULAR AGENTS (Medications to treat neuromuscular conditions)","therapeutic_class":"ALS Agents - Miscellaneous","drug_name":"Radicava ORS Starter Kit Suspension 105 MG/5ML Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"70","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"105","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"74509030001820","therapeutic_category":"NEUROMUSCULAR AGENTS (Medications to treat neuromuscular conditions)","therapeutic_class":"ALS Agents - Miscellaneous","drug_name":"Radicava ORS Suspension 105 MG/5ML Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"50","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"105","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30053060100320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Selective Estrogen Receptor Modulators (SERMs)","drug_name":"Raloxifene HCl Tablet 60 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60250060000320","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Selective Melatonin Receptor Agonists","drug_name":"Ramelteon Tablet 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"36100050000110","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Ramipril Capsule 1.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100050000140","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Ramipril Capsule 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100050000120","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Ramipril Capsule 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"36100050000130","therapeutic_category":"ANTIHYPERTENSIVES (Medications to lower blood pressure)","therapeutic_class":"ACE Inhibitors","drug_name":"Ramipril Capsule 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"32200040007420","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Antianginals-Other","drug_name":"Ranexa Tablet Extended Release 12 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32200040007430","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Antianginals-Other","drug_name":"Ranolazine ER Tablet Extended Release 12 Hour 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"32200040007420","therapeutic_category":"ANTIANGINAL AGENTS (Medications to treat chest pain )","therapeutic_class":"Antianginals-Other","drug_name":"Ranolazine ER Tablet Extended Release 12 Hour 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30905025000230","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Hyperparathyroid Treatment - Vitamin D Analogs","drug_name":"Rayaldee Capsule Extended Release 30 MCG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Capsule Extended Release","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000910","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Real Food Blends Liquid Enteral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Enteral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"Reality Swabs Pad","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"6240306045D520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Rebif Rebidose Solution Auto-Injector 22 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"REBIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240306045D540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Rebif Rebidose Solution Auto-Injector 44 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"REBIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"44","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240306045D560","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Rebif Rebidose Titration Pack Solution Auto-injector 6X8.8 & 6X22 MCG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"REBIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6X8.8 & 6X22","strength_unit_of_measure":"MCG","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240306045E520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Rebif Solution Prefilled Syringe 22 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"REBIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"22","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240306045E540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Rebif Solution Prefilled Syringe 44 MCG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"REBIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"44","strength_unit_of_measure":"MCG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"6240306045E560","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Multiple Sclerosis Agents - Interferons","drug_name":"Rebif Titration Pack Solution Prefilled Syringe 6X8.8 & 6X22 MCG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"REBIF"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6X8.8 & 6X22","strength_unit_of_measure":"MCG","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82400540102120","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythroid Maturation Agents","drug_name":"Reblozyl Solution Reconstituted 25 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82400540102140","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythroid Maturation Agents","drug_name":"Reblozyl Solution Reconstituted 75 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Reclipsen Tablet 0.15-30 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100010201820","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Recombivax HB Suspension 10 MCG/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100010201840","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Recombivax HB SUSPENSION 40 MCG/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100010201815","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Recombivax HB Suspension 5 MCG/0.5ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710001020E620","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Recombivax HB Suspension Prefilled Syringe 10 MCG/ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MCG/ML","route":"Injection","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710001020E610","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Recombivax HB Suspension Prefilled Syringe 5 MCG/0.5ML Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MCG/0.5ML","route":"Injection","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30022040000320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Cortisol Synthesis Inhibitors","drug_name":"Recorlev Tablet 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"240","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000060101805","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Reeses Pinworm Medicine Suspension 144 (50 Base) MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"144 (50 Base)","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"15000060100320","therapeutic_category":"ANTHELMINTICS (Medications to treat certain types of parasites)","therapeutic_class":"Anthelmintics","drug_name":"Reeses Pinworm Medicine Tablet 180 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12504080008020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Neuraminidase Inhibitors","drug_name":"Relenza Diskhaler Aerosol Powder Breath Activated 5 MG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/ACT","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12504080008020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Neuraminidase Inhibitors","drug_name":"Relenza Diskhaler Aerosol Powder Breath Activated 5 MG/BLISTER Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"20","quantity_limit_days":"60"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/BLISTER","route":"Inhalation","dose_form":"Aerosol Powder Breath Activated","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"ReliOn Alcohol Swabs Pad","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"ReliOn Alcohol Swabs Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27300030000925","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"ReliOn Glucose Drink Liquid 15 GM/59ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"GM/59ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030004020","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"ReliOn Glucose Gel 15 GM/38GM Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"GM/38GM","route":"Oral","dose_form":"Gel","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27309902400520","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other - Combinations","drug_name":"ReliOn Glucose Tablet Chewable 4-6 GM-MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4-6","strength_unit_of_measure":"GM-MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051030906387","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"ReliOn Insulin Syringe 31G X 5/16\" 1 ML","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 5/16\"","strength_unit_of_measure":"1 ML","route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"94100005006100","therapeutic_category":"DIAGNOSTIC PRODUCTS (Agents to help confirm certain diagnoses)","therapeutic_class":"Diagnostic Tests","drug_name":"ReliOn Ketone Strip In Vitro","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"In Vitro","dose_form":"Strip","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97051050146361","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"ReliOn Mini Pen Needles 31G X 6 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 6 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146330","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"ReliOn Pen Needles 29G X 12MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"29G X 12MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"ReliOn Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146366","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"ReliOn Pen Needles 32G X 4 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"32G X 4 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97051050146364","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Needles & Syringes","drug_name":"ReliOn Short Pen Needles 31G X 8 MM","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"31G X 8 MM","strength_unit_of_measure":null,"route":null,"dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512018000116","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Relnate DHA Capsule 28-1-200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-1-200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"40170080002070","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Remodulin Solution 100 MG/20ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/20ML","route":"Injection","dose_form":"Solution","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080002050","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Remodulin Solution 20 MG/20ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/20ML","route":"Injection","dose_form":"Solution","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080002080","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Remodulin Solution 200 MG/20ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG/20ML","route":"Injection","dose_form":"Solution","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40170080002060","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Prostaglandin Vasodilators","drug_name":"Remodulin Solution 50 MG/20ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/20ML","route":"Injection","dose_form":"Solution","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81200000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Nutritional Supplements","drug_name":"Renalcal Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Enteral Nutrition"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78133000000325","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"B-Complex w/ C & Folic Acid","drug_name":"Rena-Vite Tablet Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27280060000310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Meglitinide Analogues","drug_name":"Repaglinide Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27280060000320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Meglitinide Analogues","drug_name":"Repaglinide Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27280060000330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Meglitinide Analogues","drug_name":"Repaglinide Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"3935002000E230","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"PCSK9 Inhibitors","drug_name":"Repatha Pushtronex System Solution Cartridge 420 MG/3.5ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3.50","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"420","strength_unit_of_measure":"MG/3.5ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3935002000E520","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"PCSK9 Inhibitors","drug_name":"Repatha Solution Prefilled Syringe 140 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"140","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3935002000D520","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"PCSK9 Inhibitors","drug_name":"Repatha SureClick Solution Auto-Injector 140 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"140","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109020200320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Rescriptor Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109020200330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Non-Nucleoside Analogues","drug_name":"Rescriptor Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020042040","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Retacrit Solution 10000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020042010","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Retacrit Solution 2000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020042015","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Retacrit Solution 3000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020042020","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Retacrit Solution 4000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"82401020042060","therapeutic_category":"HEMATOPOIETIC AGENTS (Medications to enhance the growth of blood cells and treat other blood related conditions)","therapeutic_class":"Erythropoiesis-Stimulating Agents (ESAs)","drug_name":"Retacrit Solution 40000 UNIT/ML Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40000","strength_unit_of_measure":"UNIT/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21535779000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - RET Inhibitors","drug_name":"Retevmo Capsule 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535779000140","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - RET Inhibitors","drug_name":"Retevmo Capsule 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535779000340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - RET Inhibitors","drug_name":"Retevmo Tablet 120 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535779000350","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - RET Inhibitors","drug_name":"Retevmo Tablet 160 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535779000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - RET Inhibitors","drug_name":"Retevmo Tablet 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535779000330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - RET Inhibitors","drug_name":"Retevmo Tablet 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21480070200340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Menin Inhibitors","drug_name":"Revuforj Tablet 110 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"110","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21480070200350","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Menin Inhibitors","drug_name":"Revuforj Tablet 160 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93400020100922","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"Rextovy Liquid 4 MG/0.25ML Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG/0.25ML","route":"Nasal","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104515203020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Reyataz PACKET 50 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406540600320","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1F)","drug_name":"Reyvow Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406540600310","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1F)","drug_name":"Reyvow Tablet 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"2","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52601060000340","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Hepatotropics - Thyroid Hormone Receptor-Beta Agonists","drug_name":"Rezdiffra Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52601060000320","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Hepatotropics - Thyroid Hormone Receptor-Beta Agonists","drug_name":"Rezdiffra Tablet 60 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52601060000330","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Hepatotropics - Thyroid Hormone Receptor-Beta Agonists","drug_name":"Rezdiffra Tablet 80 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21534960000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Isocitrate Dehydrogenase-1 (IDH1) Inhibitors","drug_name":"Rezlidhia Capsule 150 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"99398510500320","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"ROCK Inhibitors","drug_name":"Rezurock Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"2710400305D220","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Human Insulin","drug_name":"Rezvoglar KwikPen Solution Pen-Injector 100 UNIT/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"UNIT/ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"12353070000120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Ribavirin Capsule 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12353070000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agents","drug_name":"Ribavirin Tablet 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"77102010000130","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-2","drug_name":"Riboflavin Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77102010000120","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-2","drug_name":"Riboflavin Capsule 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"77102010000370","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Vitamin B-2","drug_name":"Riboflavin Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"09000075000120","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Rifabutin Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000080000105","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"rifAMPin Capsule 150 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000080000110","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"rifAMPin Capsule 300 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000080002120","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Rifampin Solution Reconstituted 600 MG Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Intravenous","dose_form":"Solution Reconstituted","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"74503070000320","therapeutic_category":"NEUROMUSCULAR AGENTS (Medications to treat neuromuscular conditions)","therapeutic_class":"Benzathiazoles","drug_name":"Riluzole Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12500070100320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Influenza Agents","drug_name":"riMANTAdine HCl Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99750020002000","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Irrigation Solutions","drug_name":"Ringers Irrigation Solution Irrigation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Irrigation","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97100550006200","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Spacer/Aerosol-Holding Chambers & Supplies","drug_name":"RiteFlo Device","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12104560000320","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - Protease Inhibitors","drug_name":"Ritonavir Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83370060000310","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Direct Factor Xa Inhibitors","drug_name":"Rivaroxaban Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051040008540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Rivastigmine Patch 24 Hour 13.3 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"13.3","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051040008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Rivastigmine Patch 24 Hour 4.6 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4.6","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051040008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Rivastigmine Patch 24 Hour 9.5 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"9.5","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051040200110","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Rivastigmine Tartrate Capsule 1.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051040200120","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Rivastigmine Tartrate Capsule 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051040200130","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Rivastigmine Tartrate Capsule 4.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62051040200140","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Cholinomimetics - ACHE Inhibitors","drug_name":"Rivastigmine Tartrate Capsule 6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Namenda XR","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56626050602020","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Small Interfering Ribonucleic Acid Agents (siRNA)","drug_name":"Rivfloza Solution 80 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5662605060E520","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Small Interfering Ribonucleic Acid Agents (siRNA)","drug_name":"Rivfloza Solution Prefilled Syringe 128 MG/0.8ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"0.80","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"128","strength_unit_of_measure":"MG/0.8ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5662605060E530","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Small Interfering Ribonucleic Acid Agents (siRNA)","drug_name":"Rivfloza Solution Prefilled Syringe 160 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"93400020100915","therapeutic_category":"ANTIDOTES AND SPECIFIC ANTAGONISTS (Medications to treat drug overdose)","therapeutic_class":"Opioid Antagonists","drug_name":"RiVive Liquid 3 MG/0.1ML Nasal","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"180"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG/0.1ML","route":"Nasal","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406060100320","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Rizatriptan Benzoate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":"Triptans: Zolmitriptan","step_therapy_step_2_number":"1"}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406060100310","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Rizatriptan Benzoate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":"Triptans: Zolmitriptan","step_therapy_step_2_number":"1"}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406060107230","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Rizatriptan Benzoate Tablet Dispersible 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":"Triptans: Zolmitriptan","step_therapy_step_2_number":"1"}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"67406060107220","therapeutic_category":"MIGRAINE PRODUCTS (Medications to treat migraine headaches)","therapeutic_class":"Selective Serotonin Agonists 5-HT(1)","drug_name":"Rizatriptan Benzoate Tablet Dispersible 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Migraine Agents","step_therapy_step_number":"1","step_therapy_group_2":"Triptans: Zolmitriptan","step_therapy_step_2_number":"1"}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"18","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44450065000310","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Selective Phosphodiesterase 4 (PDE4) Inhibitors","drug_name":"Roflumilast Tablet 250 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44450065000320","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Selective Phosphodiesterase 4 (PDE4) Inhibitors","drug_name":"Roflumilast Tablet 500 MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21531780000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - CSF1R Kinase Inhibitors","drug_name":"Romvimza Capsule 14 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531780000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - CSF1R Kinase Inhibitors","drug_name":"Romvimza Capsule 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531780000140","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - CSF1R Kinase Inhibitors","drug_name":"Romvimza Capsule 30 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"8","quantity_limit_days":"28"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070107550","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl ER Tablet Extended Release 24 Hour 12 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"12","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070107520","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl ER Tablet Extended Release 24 Hour 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070107530","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl ER Tablet Extended Release 24 Hour 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070107535","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl ER Tablet Extended Release 24 Hour 6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070107540","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl ER Tablet Extended Release 24 Hour 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070100310","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl Tablet 0.25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070100315","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070100320","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070100330","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070100337","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl Tablet 3 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070100344","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl Tablet 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73203070100350","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Nonergoline Dopamine Receptor Agonists","drug_name":"rOPINIRole HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Pramipexole ER","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"39400060100310","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Rosuvastatin Calcium Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Ezetimibe","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400060100320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Rosuvastatin Calcium Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Ezetimibe","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400060100340","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Rosuvastatin Calcium Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Ezetimibe","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400060100305","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Rosuvastatin Calcium Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Ezetimibe","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"17100075001920","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Rotarix Suspension Reconstituted Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100075102020","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"RotaTeq Solution Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533820000120","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Tropomyosin Receptor Kinase Inhibitors","drug_name":"Rozlytrek Capsule 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21533820000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Tropomyosin Receptor Kinase Inhibitors","drug_name":"Rozlytrek Capsule 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21533820003020","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Tropomyosin Receptor Kinase Inhibitors","drug_name":"Rozlytrek Packet 50 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21535570200320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Poly (ADP-ribose) Polymerase (PARP) Inhibitors","drug_name":"Rubraca Tablet 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535570200325","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Poly (ADP-ribose) Polymerase (PARP) Inhibitors","drug_name":"Rubraca Tablet 250 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"21535570200330","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Poly (ADP-ribose) Polymerase (PARP) Inhibitors","drug_name":"Rubraca Tablet 300 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"300","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"72600065001820","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Rufinamide Suspension 40 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600065000320","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Rufinamide Tablet 200 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"72600065000330","therapeutic_category":"ANTICONVULSANTS (Medications to to help control seizures)","therapeutic_class":"Anticonvulsants - Misc.","drug_name":"Rufinamide Tablet 400 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12102330407420","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - gp120-Directed Attachment Inhibitor","drug_name":"Rukobia Tablet Extended Release 12 Hour 600 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"600","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release 12 Hour","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533030000130","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Rydapt CAPSULE 25 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40992002600320","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Neprilysin Inhib (ARNI)-Angiotensin II Recept Antag Comb","drug_name":"Sacubitril-Valsartan Tablet 24-26 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"24-26","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40992002600330","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Neprilysin Inhib (ARNI)-Angiotensin II Recept Antag Comb","drug_name":"Sacubitril-Valsartan Tablet 49-51 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"49-51","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40992002600340","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Neprilysin Inhib (ARNI)-Angiotensin II Recept Antag Comb","drug_name":"Sacubitril-Valsartan Tablet 97-103 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"97-103","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990003200330","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Safyral Tablet 3-0.03-0.451 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3-0.03-0.451","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020102120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Saizen Solution Reconstituted 5 MG Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020102130","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Saizen Solution Reconstituted 8.8 MG Injection","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"GROWTH HORMONE"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8.8","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"8582004010E520","therapeutic_category":"HEMATOLOGICAL AGENTS - MISC. (Medications to treat hemophilia and other blood related conditions)","therapeutic_class":"Bradykinin B2 Receptor Antagonists","drug_name":"Sajazir Solution Prefilled Syringe 30 MG/3ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100075000305","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Salsalate Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100075000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"Salsalate Tablet 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99402020002010","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Cyclosporine Analogs","drug_name":"SandIMMUNE Solution 100 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908565103020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Sapropterin Dihydrochloride Packet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908565103040","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Sapropterin Dihydrochloride Packet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908565100320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Sapropterin Dihydrochloride Tablet 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908565107320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Phenylketonuria Treatment - Agents","drug_name":"Sapropterin Dihydrochloride Tablet Soluble 100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Soluble","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004115","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Sarnol-HC Lotion 1 % External","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"83100020356420","therapeutic_category":"ANTICOAGULANTS (Medications that thin the blood)","therapeutic_class":"Heparins And Heparinoid-Like Agents","drug_name":"Sash Kit Kit 100-0.9 UNIT/ML-% Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100-0.9","strength_unit_of_measure":"UNIT/ML-%","route":"Intravenous","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27550065100320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"sAXagliptin HCl Tablet 2.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27550065100330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Dipeptidyl Peptidase-4 (DPP-4) Inhibitors","drug_name":"sAXagliptin HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"6125205000D220","therapeutic_category":"ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS (Medications to manage the symptoms of Attention Deficit Hyperactivity Disorder and excessive sleepiness)","therapeutic_class":"Anti-Obesity - GLP-1 Receptor Agonists","drug_name":"Saxenda Solution Pen-Injector 18 MG/3ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"15","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 20 Years"}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18","strength_unit_of_measure":"MG/3ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"49200020100303","therapeutic_category":"ULCER DRUGS/ANTISPASMODICS/ANTICHOLINERGICS(Medications to treat stomach ulcers and other stomach conditions)","therapeutic_class":"H-2 Antagonists","drug_name":"SB Acid Reducer raNITIdine Tablet 75 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"SB Alcohol Prep Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"SB Antacid Extra Strength Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"SB Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"SB Anti-Diarrhea Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"SB Anti-Gas Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SB Aspirin EC Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SB Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90100010004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antibiotics - Topical","drug_name":"SB Bacitracin Ointment 500 UNIT/GM External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"UNIT/GM","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100055000307","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SB Backache Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"SB Bisacodyl Laxative EC Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000307","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"SB Bismuth Tablet 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640350","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SB Calcium + D Tablet 600-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SB Childrens Aspirin Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007210","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Childrens Non-Aspirin Tablet Dispersible 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"SB Gas Relief Suspension 40 MG/0.6ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.6ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"SB Gas Relief Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"SB Gentle Lax-Women Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"SB Hydrocortisone Max St Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100020001810","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"SB Infants Ibuprofen Suspension 50 MG/1.25ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG/1.25ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90900035000910","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"SB Lice Treatment Liquid 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SB Low Dose ASA EC Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"SB Motion Sickness Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"66100060100303","therapeutic_category":"ANALGESICS - ANTI-INFLAMMATORY (Medications to treat pain and inflammation)","therapeutic_class":"Nonsteroidal Anti-inflammatory Agents (NSAIDs)","drug_name":"SB Naproxen Sodium Tablet 220 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"220","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Non-Aspirin Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Non-Aspirin Jr Strength Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Non-Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000515","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Non-Aspirin Tablet Chewable 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000505","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Non-Aspirin Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79100070000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium","drug_name":"SB Oyster Shell Calcium Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010001840","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Pain Reliever Childrens Suspension 160 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SB Pain Reliever Ex St Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"SB Senna-Lax Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004118","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"Scalacort Lotion 2 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"External","dose_form":"Lotion","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531806100380","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Scemblix Tablet 100 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531806100320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Scemblix Tablet 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21531806100340","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - BCR-ABL Kinase Inhibitors","drug_name":"Scemblix Tablet 40 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002450320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Segluromet Tablet 2.5-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002450310","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Segluromet Tablet 2.5-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002450340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Segluromet Tablet 7.5-1000 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5-1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27996002450330","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 Inhibitor-Biguanide Comb","drug_name":"Segluromet Tablet 7.5-500 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.5-500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025058502E520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Selarsdi Solution Prefilled Syringe 45 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"45","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025058502E540","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Selarsdi Solution Prefilled Syringe 90 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73300030100120","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Monoamine Oxidase Inhibitors","drug_name":"Selegiline HCl Capsule 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"73300030100320","therapeutic_category":"ANTIPARKINSON AND RELATED THERAPY AGENTS(Medications to treat parkinsons disease and related conditions)","therapeutic_class":"Antiparkinson Monoamine Oxidase Inhibitors","drug_name":"Selegiline HCl Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12102060002020","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - CCR5 Antagonists (Entry Inhibitor)","drug_name":"Selzentry Solution 20 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512070000330","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Se-Natal 19 Tablet 29-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"78512015000530","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"Se-Natal 19 Tablet Chewable 29-1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"29-1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply via mail order","protected_class":false,"emergency_fill":false},{"gpi":"46200060200110","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna Capsule 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna Laxative Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060201220","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna Liquid 8.8 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.8","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46991002770320","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives & DSS","drug_name":"Senna S Tablet 8.6-50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6-50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200315","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna Smooth Tablet 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060101207","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna Syrup 176 MG/5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"176","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Syrup","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna-Lax Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna-Tabs Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senna-Time Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Sennosides Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"Senokot Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020102118","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Serostim Solution Reconstituted 4 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SEROSTIM"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020102121","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Serostim Solution Reconstituted 5 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SEROSTIM"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30100020102125","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Serostim Solution Reconstituted 6 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SEROSTIM"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Solution Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52800070053020","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Phosphate Binder Agents","drug_name":"Sevelamer Carbonate Packet 0.8 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.8","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52800070053040","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Phosphate Binder Agents","drug_name":"Sevelamer Carbonate Packet 2.4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52800070050340","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Phosphate Binder Agents","drug_name":"Sevelamer Carbonate Tablet 800 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"800","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100095401920","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Shingrix Suspension Reconstituted 50 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Suspension Reconstituted","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170075202020","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Signifor Solution 0.3 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SIGNIFOR"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.3","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170075202030","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Signifor Solution 0.6 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SIGNIFOR"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.6","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170075202040","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Signifor Solution 0.9 MG/ML Subcutaneous","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SIGNIFOR"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"40143060100320","therapeutic_category":"CARDIOVASCULAR AGENTS - MISC. (Medications to treat other heart related conditions)","therapeutic_class":"Pulmonary Hypertension - Phosphodiesterase Inhibitors","drug_name":"Sildenafil Citrate Tablet 20 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"REVATIO (sildenafil citrate)"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56852060000120","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Alpha 1-Adrenoceptor Antagonists","drug_name":"Silodosin Capsule 4 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"56852060000140","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Alpha 1-Adrenoceptor Antagonists","drug_name":"Silodosin Capsule 8 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90450030003710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Burn Products","drug_name":"Silver sulfADIAZINE Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Simeped Suspension 40 MG/0.6ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.6ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Simethicone Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020001810","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Simethicone Suspension 40 MG/0.6ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG/0.6ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000510","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"Simethicone Tablet Chewable 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Similac Advance Organic Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Similac for Spit-Up Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000002900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Similac PM Powder Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Similac Sensitive Early Shield Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Similac Soy Isomil Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"81100000000900","therapeutic_category":"DIETARY PRODUCTS/DIETARY MANAGEMENT PRODUCTS (Agents to support dietary and nutritional needs)","therapeutic_class":"Infant Foods","drug_name":"Similac Total Comfort Liquid Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Liquid","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400075000320","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Simvastatin Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400075000330","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Simvastatin Tablet 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400075000340","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Simvastatin Tablet 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400075000310","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Simvastatin Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"39400075000360","therapeutic_category":"ANTIHYPERLIPIDEMICS (Medications to help manage high cholesterol and high triglycerides)","therapeutic_class":"HMG CoA Reductase Inhibitors","drug_name":"Simvastatin Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"99404070002020","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Sirolimus Solution 1 MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99404070000310","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Sirolimus Tablet 0.5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99404070000320","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Sirolimus Tablet 1 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99404070000330","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Macrolide Immunosuppressants","drug_name":"Sirolimus Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000015100320","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Sirturo TABLET 100 MG ORAL","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"09000015100310","therapeutic_category":"ANTIMYCOBACTERIAL AGENTS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Antimycobacterial Agents","drug_name":"Sirturo Tablet 20 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"16230070200320","therapeutic_category":"ANTI-INFECTIVE AGENTS - MISC. (Medications to treat certain types infection)","therapeutic_class":"Oxazolidinones","drug_name":"Sivextro Tablet 200 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"6","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"74135060000120","therapeutic_category":"NEUROMUSCULAR AGENTS (Medications to treat neuromuscular conditions)","therapeutic_class":"Friedrich's Ataxia Agents - Nrf2 Pathway Activators","drug_name":"Skyclarys Capsule 50 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"90","quantity_limit_days":"30"}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25200050005310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - IUD","drug_name":"Skyla INTRAUTERINE DEVICE 13.5 MG INTRAUTERINE","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"13.5","strength_unit_of_measure":"MG","route":"Intrauterine","dose_form":"Intrauterine Device","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057070F820","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Skyrizi (150 MG Dose) Prefilled Syringe Kit 75 MG/0.83ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"84"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"75","strength_unit_of_measure":"MG/0.83ML","route":"Subcutaneous","dose_form":"Prefilled Syringe Kit","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057070D520","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Skyrizi Pen Solution Auto-Injector 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"84"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Auto-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5250406070E210","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Interleukin Antagonists","drug_name":"Skyrizi Solution Cartridge 180 MG/1.2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1.20","quantity_limit_days":"56"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG/1.2ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"5250406070E220","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Interleukin Antagonists","drug_name":"Skyrizi Solution Cartridge 360 MG/2.4ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"2.40","quantity_limit_days":"56"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"360","strength_unit_of_measure":"MG/2.4ML","route":"Subcutaneous","dose_form":"Solution Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"9025057070E540","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Antipsoriatics - Systemic","drug_name":"Skyrizi Solution Prefilled Syringe 150 MG/ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"1","quantity_limit_days":"84"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"150","strength_unit_of_measure":"MG/ML","route":"Subcutaneous","dose_form":"Solution Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E145","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 11 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"11","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E150","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 13.3 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"13.3","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E110","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 3 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E115","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 3.6 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"3.6","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E120","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 4.3 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4.3","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E125","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 5.2 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5.2","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E130","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 6.3 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"6.3","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E135","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 7.6 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"7.6","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000380E140","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Skytrofa Cartridge 9.1 MG Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"9.1","strength_unit_of_measure":"MG","route":"Subcutaneous","dose_form":"Cartridge","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"Sleep Aid (Doxylamine) Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"Sleep Aid Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25100055000320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Progestin Contraceptives - Oral","drug_name":"Slynd Tablet 4 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104020003710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"SM 3-Day Vaginal Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SM 8 Hour Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"SM Alcohol Prep Pad","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"97703040004300","therapeutic_category":"MEDICAL DEVICES AND SUPPLIES (Devices to support the administration of insulin and testing of blood sugar)","therapeutic_class":"Applicators,Cotton Balls,etc","drug_name":"SM Alcohol Prep Pad 70 %","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"70","strength_unit_of_measure":"%","route":null,"dose_form":"Pad","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"47100020100105","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"SM Anti-Diarrheal Capsule 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020100305","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"SM Anti-Diarrheal Tablet 2 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000420","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SM Arthritis Pain Relief Tablet Extended Release 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Extended Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SM Aspirin Adult Low Strength Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SM Aspirin Adult Low Strength Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SM Aspirin EC Low Strength Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000605","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SM Aspirin EC Tablet Delayed Release 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SM Aspirin Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64109902040320","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylate Combinations","drug_name":"SM Aspirin Tri-Buffered Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SM Calcium 500/Vitamin D3 Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SM Calcium 600/Vitamin D Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"SM Calcium Antacid Ex St Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000510","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"SM Calcium Antacid Tablet Chewable 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000545","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"SM Calcium Antacid Ultra St Tablet Chewable 1000 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1000","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640357","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SM Calcium/Vitamin D Tablet 600-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640335","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SM Calcium-Vitamin D Tablet 500-5 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-5","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640354","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SM Calcium-Vitamin D Tablet 600-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"600-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000510","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"SM Childrens Aspirin Tablet Chewable 81 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104020003705","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"SM Clotrimazole Vaginal Cream 1 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46109902105100","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Saline Laxative Mixtures","drug_name":"SM Enema Enema Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Rectal","dose_form":"Enema","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48990002200505","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacid Combinations","drug_name":"SM Foaming Antacid Tablet Chewable 80-20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80-20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000135","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"SM Gas Relief Antiflatuent Capsule 180 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"180","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000120","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"SM Gas Relief Extra Strength Capsule 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"52200020000530","therapeutic_category":"GASTROINTESTINAL AGENTS - MISC. (Miscellaneous medications to support the digestive process)","therapeutic_class":"Antiflatulents","drug_name":"SM Gas Relief Tablet Chewable 125 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"125","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200010000610","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"SM Gentle Laxative Tablet Delayed Release 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27300030000515","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Diabetic Other","drug_name":"SM Glucose Tablet Chewable 4 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075003715","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"SM Hydrocortisone Cream 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"90550075004210","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"SM Hydrocortisone Max St Ointment 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90550075004205","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Corticosteroids - Topical","drug_name":"SM Hydrocortisone Ointment 0.5 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.5","strength_unit_of_measure":"%","route":"External","dose_form":"Ointment","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90900035000910","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"SM Lice Treatment Liquid 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Liquid","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47100020101820","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antiperistaltic Agents","drug_name":"SM Loperamide HCl Suspension 1 MG/7.5ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"MG/7.5ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79400010360320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Magnesium","drug_name":"SM Magnesium Oxide Tablet 250 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"250","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106464","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"SM Miconazole 3 Applicator Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050106410","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"SM Miconazole 3 Kit 200 & 2 MG-% (9GM) Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200 & 2","strength_unit_of_measure":"MG-% (9GM)","route":"Vaginal","dose_form":"Kit","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050103710","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"SM Miconazole 7 Cream 2 % Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"%","route":"Vaginal","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"55104050105205","therapeutic_category":"VAGINAL AND RELATED PRODUCTS(Medications to treat vaginal infections or hormonal supplementation)","therapeutic_class":"Imidazole-Related Antifungals","drug_name":"SM Miconazole 7 Suppository 100 MG Vaginal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Vaginal","dose_form":"Suppository","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200030000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"SM Motion Sickness Relief Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"50200050000310","therapeutic_category":"ANTIEMETICS (Medications to help control nausea and vomiting)","therapeutic_class":"Antiemetics - Anticholinergic","drug_name":"SM Motion Sickness Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Anti-Emetics: Akynzeo, Granisetron, Aprepitant, Varubi","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002820","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"SM Nicotine Gum 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004710","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"SM Nicotine Lozenge 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008530","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"SM Nicotine Patch 24 Hour 14 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"14","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008540","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"SM Nicotine Patch 24 Hour 21 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"21","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100005008520","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"SM Nicotine Patch 24 Hour 7 MG/24HR Transdermal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"180","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"MG/24HR","route":"Transdermal","dose_form":"Patch 24 Hour","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010002810","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"SM Nicotine Polacrilex Gum 2 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4320","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Gum","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"62100010004720","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Smoking Deterrents","drug_name":"SM Nicotine Polacrilex Lozenge 4 MG Mouth/Throat","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Nicotrol","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"3600","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"4","strength_unit_of_measure":"MG","route":"Mouth/Throat","dose_form":"Lozenge","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"78512018006325","therapeutic_category":"MULTIVITAMINS (Vitamins)","therapeutic_class":"Prenatal MV & Min w/FE-FA","drug_name":"SM One Daily Prenatal 28-0.8 & 440 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":true,"age_restriction_detail":"Minimum Age: None Maximum Age: 45 Years"}],"gender_restriction":[{"gender_restriction_required":true,"gender_restriction_detail":"Female Only"}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"28-0.8 & 440","strength_unit_of_measure":"MG","route":"Oral","dose_form":null,"multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SM Oyster Shell Calcium/Vit D Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79109902640340","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Calcium Combinations","drug_name":"SM Oyster Shell Calcium/Vit D3 Tablet 500-10 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500-10","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SM Pain Relief Extra Strength Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000115","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SM Pain Reliever Ex St Capsule 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000315","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SM Pain Reliever Ex St Tablet 500 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64200010000310","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SM Pain Reliever Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79700050000370","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Potassium","drug_name":"SM Potassium Tablet 595 (99 K) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"595 (99 K)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"64200010007220","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Analgesics Other","drug_name":"SM Rapid Melts Junior Tablet Dispersible 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Dispersible","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46200060200303","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Stimulant Laxatives","drug_name":"SM Senna Laxative Tablet 8.6 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"8.6","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"60300010100310","therapeutic_category":"HYPNOTICS/SEDATIVES/SLEEP DISORDER AGENTS (Medications to cause sleepiness)","therapeutic_class":"Antihistamine Hypnotics","drug_name":"SM Sleep Aid Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48300010000520","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Calcium Salts","drug_name":"SM Smooth Antacid Ex St Tablet Chewable 750 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"750","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000307","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"SM Stomach Relief Tablet 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"SM Stomach Relief Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46600033003020","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Laxatives - Miscellaneous","drug_name":"Smooth LAX Packet 17 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"17","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Packet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48200010000310","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Bicarbonate","drug_name":"Sodium Bicarbonate Tablet 325 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"325","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"48200010000325","therapeutic_category":"ANTACIDS (Medications to suppress acid content of the stomach)","therapeutic_class":"Antacids - Bicarbonate","drug_name":"Sodium Bicarbonate Tablet 650 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"650","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"86804030102005","therapeutic_category":"OPHTHALMIC AGENTS (Medications to treat pain, inflammation and infection of the eye)","therapeutic_class":"Ophthalmic Hyperosmolar Products","drug_name":"Sodium Chloride (Hypertonic) Solution 5 % Ophthalmic","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"Ophthalmic","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010002018","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride (PF) Solution 0.9 % Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"43400010002520","therapeutic_category":"COUGH/COLD/ALLERGY (Medications to treat cough, cold or allergy symptoms)","therapeutic_class":"Misc. Respiratory Inhalants","drug_name":"Sodium Chloride Nebulization Solution 0.9 % Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"43400010002540","therapeutic_category":"COUGH/COLD/ALLERGY (Medications to treat cough, cold or allergy symptoms)","therapeutic_class":"Misc. Respiratory Inhalants","drug_name":"Sodium Chloride NEBULIZATION SOLUTION 10 % INHALATION","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"%","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"43400010002530","therapeutic_category":"COUGH/COLD/ALLERGY (Medications to treat cough, cold or allergy symptoms)","therapeutic_class":"Misc. Respiratory Inhalants","drug_name":"Sodium Chloride Nebulization Solution 3 % Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"%","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"43400010002535","therapeutic_category":"COUGH/COLD/ALLERGY (Medications to treat cough, cold or allergy symptoms)","therapeutic_class":"Misc. Respiratory Inhalants","drug_name":"Sodium Chloride Nebulization Solution 7 % Inhalation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"7","strength_unit_of_measure":"%","route":"Inhalation","dose_form":"Nebulization Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010002010","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride Solution 0.45 % Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.45","strength_unit_of_measure":"%","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010002020","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride Solution 0.9 % Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"Injection","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010002021","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride Solution 0.9 % Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"56700060002010","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Genitourinary Irrigants","drug_name":"Sodium Chloride Solution 0.9 % Irrigation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"Irrigation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010002050","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride Solution 2.5 MEQ/ML Injection","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MEQ/ML","route":"Injection","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010002030","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride Solution 3 % Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"%","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010002040","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride Solution 5 % Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"%","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79750010000320","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Sodium","drug_name":"Sodium Chloride Tablet 1 GM Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1","strength_unit_of_measure":"GM","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79300020002050","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Sodium Fluoride Solution 1.1 (0.5 F) MG/ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.1 (0.5 F)","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79300020000310","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Sodium Fluoride TABLET 1.1 (0.5 F) MG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.1 (0.5 F)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79300020000315","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Sodium Fluoride TABLET 2.2 (1 F) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.2 (1 F)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79300020000505","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Sodium Fluoride Tablet Chewable 0.55 (0.25 F) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.55 (0.25 F)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79300020000510","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Sodium Fluoride Tablet Chewable 1.1 (0.5 F) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"1.1 (0.5 F)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"79300020000515","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Fluoride","drug_name":"Sodium Fluoride Tablet Chewable 2.2 (1 F) MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"2.2 (1 F)","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"62450060202020","therapeutic_category":"PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS - MISC. (Miscellaneous medications to treat conditions of the nervous system)","therapeutic_class":"Anti-Cataplectic Agents","drug_name":"Sodium Oxybate Solution 500 MG/ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":true,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG/ML","route":"Oral","dose_form":"Solution","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908060002950","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Urea Cycle Disorder - Agents","drug_name":"Sodium Phenylbutyrate POWDER 3 GM/TSP Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3","strength_unit_of_measure":"GM/TSP","route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30908060000320","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Urea Cycle Disorder - Agents","drug_name":"Sodium Phenylbutyrate Tablet 500 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"500","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"79600020102030","therapeutic_category":"MINERALS & ELECTROLYTES (Agents to supplemental chemical imbalances)","therapeutic_class":"Phosphate","drug_name":"Sodium Phosphates Solution 45 MMOLE/15ML Intravenous","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"45","strength_unit_of_measure":"MMOLE/15ML","route":"Intravenous","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99450010002900","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Potassium Removing Agents","drug_name":"Sodium Polystyrene Sulfonate Powder Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Oral","dose_form":"Powder","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99450010001840","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Potassium Removing Agents","drug_name":"Sodium Polystyrene Sulfonate Suspension 15 GM/60ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"GM/60ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99450010001870","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Potassium Removing Agents","drug_name":"Sodium Polystyrene Sulfonate Suspension 30 GM/120ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"GM/120ML","route":"Rectal","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"99450010001870","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Potassium Removing Agents","drug_name":"Sodium Polystyrene Sulfonate Suspension 50 GM/200ML Rectal","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"GM/200ML","route":"Rectal","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12359902650330","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Hepatitis C Agent - Combinations","drug_name":"Sofosbuvir-Velpatasvir Tablet 400-100 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"84","quantity_limit_days":"365"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"400-100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"M","prescriber_note":"Prior Authorization may apply","protected_class":false,"emergency_fill":false},{"gpi":"3010000720D220","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Sogroya Solution Pen-Injector 10 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000720D230","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Sogroya Solution Pen-Injector 15 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"3010000720D210","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Growth Hormones","drug_name":"Sogroya Solution Pen-Injector 5 MG/1.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG/1.5ML","route":"Subcutaneous","dose_form":"Solution Pen-Injector","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002100320","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Solia TABLET 0.15-30 MG-MCG ORAL","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.15-30","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100055200330","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"Solifenacin Succinate Tablet 10 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"54100055200320","therapeutic_category":"URINARY ANTISPASMODICS (Medications to improve bladder control)","therapeutic_class":"Urinary Antispasmodic - Antimuscarinic (Anticholinergic)","drug_name":"Solifenacin Succinate Tablet 5 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Overactive Bladder","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21402680102020","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antiestrogens","drug_name":"Soltamox Solution 10 MG/5ML Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"10","strength_unit_of_measure":"MG/5ML","route":"Oral","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"22100025402150","therapeutic_category":"CORTICOSTEROIDS (Medications to decrease inflammation)","therapeutic_class":"Glucocorticosteroids","drug_name":"Solu-CORTEF Solution Reconstituted 100 MG Injection","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Injection","dose_form":"Solution Reconstituted","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170050102040","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Somatuline Depot Solution 120 MG/0.5ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SOMATULINE DEPOT"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG/0.5ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"O","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170050102025","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Somatuline Depot Solution 60 MG/0.2ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SOMATULINE DEPOT"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"60","strength_unit_of_measure":"MG/0.2ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30170050102030","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Somatostatic Agents","drug_name":"Somatuline Depot Solution 90 MG/0.3ML Subcutaneous","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"SOMATULINE DEPOT"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"90","strength_unit_of_measure":"MG/0.3ML","route":"Subcutaneous","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000307","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Soothe Tablet 262 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Soothe Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"21533060400320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"SORAfenib Tosylate Tablet 200 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"120","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"200","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Partial Fill","protected_class":false,"emergency_fill":false},{"gpi":"56700082002010","therapeutic_category":"GENITOURINARY AGENTS - MISCELLANEOUS (Miscellaneous medications to treat chemical imbalances or prostate related disorders)","therapeutic_class":"Genitourinary Irrigants","drug_name":"Sorbitol Solution 3.3 % Irrigation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"3.3","strength_unit_of_measure":"%","route":"Irrigation","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"33100045120315","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Sotalol HCl (AF) Tablet 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100045100315","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Sotalol HCl Tablet 120 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"120","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100045100320","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Sotalol HCl Tablet 160 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"160","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100045100330","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Sotalol HCl Tablet 240 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"240","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"33100045100310","therapeutic_category":"BETA BLOCKERS (Medications to lower blood pressure or help to control heart rate)","therapeutic_class":"Beta Blockers Non-Selective","drug_name":"Sotalol HCl Tablet 80 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"80","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"02300045200340","therapeutic_category":"CEPHALOSPORINS (Medications to treat certain types of bacterial infection)","therapeutic_class":"Cephalosporins - 3rd Generation","drug_name":"Spectracef Tablet 400 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"400","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"17100002401840","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Spikevax COVID-19 Vaccine Suspension 100 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"100","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Suspension","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"1710000240E640","therapeutic_category":"VACCINES (Vaccines to prevent certain viral infections)","therapeutic_class":"Viral Vaccines","drug_name":"Spikevax Suspension Prefilled Syringe 50 MCG/0.5ML Intramuscular","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"50","strength_unit_of_measure":"MCG/0.5ML","route":"Intramuscular","dose_form":"Suspension Prefilled Syringe","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90900048001820","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Scabicides & Pediculicides","drug_name":"Spinosad Suspension 0.9 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"0.9","strength_unit_of_measure":"%","route":"External","dose_form":"Suspension","multisource_indicator":"M","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44100080080130","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Bronchodilators - Anticholinergics","drug_name":"Spiriva HandiHaler Capsule 18 MCG Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"18","strength_unit_of_measure":"MCG","route":"Inhalation","dose_form":"Capsule","multisource_indicator":"O","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44100080083410","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Bronchodilators - Anticholinergics","drug_name":"Spiriva Respimat Aerosol Solution 1.25 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.25","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"44100080083420","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Bronchodilators - Anticholinergics","drug_name":"Spiriva Respimat Aerosol Solution 2.5 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"4","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37500020000315","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Potassium Sparing Diuretics","drug_name":"Spironolactone Tablet 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37500020000305","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Potassium Sparing Diuretics","drug_name":"Spironolactone Tablet 25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37500020000310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Potassium Sparing Diuretics","drug_name":"Spironolactone Tablet 50 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"50","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"37990002200310","therapeutic_category":"DIURETICS (Medications to control the volume of certain bodily fluids)","therapeutic_class":"Diuretic Combinations","drug_name":"Spironolactone-HCTZ Tablet 25-25 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"25-25","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"25990002950310","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Sprintec 28 Tablet 0.25-35 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.25-35","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"25990002400305","therapeutic_category":"CONTRACEPTIVES (Medications that can prevent pregnancy)","therapeutic_class":"Combination Contraceptives - Oral","drug_name":"Sronyx TABLET 0.1-20 MG-MCG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"0.1-20","strength_unit_of_measure":"MG-MCG","route":"Oral","dose_form":"Tablet","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"90450030003710","therapeutic_category":"DERMATOLOGICALS (Medications to decrease inflammation on the skin)","therapeutic_class":"Burn Products","drug_name":"SSD (silver sulfADIAZINE) Cream 1 % External","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1","strength_unit_of_measure":"%","route":"External","dose_form":"Cream","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"64100010000601","therapeutic_category":"ANALGESICS - NonNarcotic (Medications to treat pain that are not narcotics)","therapeutic_class":"Salicylates","drug_name":"St Joseph Aspirin Tablet Delayed Release 81 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":false,"maintenance":false,"strength":"81","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Delayed Release","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12108070000115","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Thymidines","drug_name":"Stavudine Capsule 15 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12108070000120","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Thymidines","drug_name":"Stavudine Capsule 20 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"20","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12108070000130","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Thymidines","drug_name":"Stavudine Capsule 30 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"30","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12108070000140","therapeutic_category":"ANTIVIRALS (Medications to treat certain types of viral infection)","therapeutic_class":"Antiretrovirals - RTI-Nucleoside Analogues-Thymidines","drug_name":"Stavudine Capsule 40 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"27700055200340","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Steglatro Tablet 15 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"30","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"15","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"27700055200320","therapeutic_category":"ANTIDIABETICS (Medications to help control blood sugar levels in patients with diabetes)","therapeutic_class":"Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors","drug_name":"Steglatro Tablet 5 MG Oral","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":true,"step_therapy_type":null,"step_therapy_group":"Oral Antidiabetic Agents","step_therapy_step_number":"1","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"60","quantity_limit_days":"30"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"5","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"99750005002000","therapeutic_category":"MISCELLANEOUS THERAPEUTIC CLASSES (Medications to suppress the immune system and other miscellaneous medications)","therapeutic_class":"Irrigation Solutions","drug_name":"Sterile Water for Irrigation Solution Irrigation","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":true,"maintenance":false,"strength":null,"strength_unit_of_measure":null,"route":"Irrigation","dose_form":"Solution","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"30201010102015","therapeutic_category":"ENDOCRINE AND METABOLIC AGENTS - MISC. (Miscellaneous medications to treat hormone related conditions)","therapeutic_class":"Vasopressin","drug_name":"Stimate Solution 1.5 MG/ML Nasal","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"1.5","strength_unit_of_measure":"MG/ML","route":"Nasal","dose_form":"Solution","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"44209902923420","therapeutic_category":"ANTIASTHMATIC AND BRONCHODILATOR AGENTS (Medications to improve breathing in asthma and COPD)","therapeutic_class":"Adrenergic Combinations","drug_name":"Stiolto Respimat Aerosol Solution 2.5-2.5 MCG/ACT Inhalation","drug_tier":"Tier 2","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"2.5-2.5","strength_unit_of_measure":"MCG/ACT","route":"Inhalation","dose_form":"Aerosol Solution","multisource_indicator":"N","prescriber_note":"Eligible for 90 day supply","protected_class":false,"emergency_fill":false},{"gpi":"21533050000320","therapeutic_category":"ANTINEOPLASTICS AND ADJUNCTIVE THERAPIES (Medications to treat cancer and cancer related conditions)","therapeutic_class":"Antineoplastic - Multikinase Inhibitors","drug_name":"Stivarga Tablet 40 MG Oral","drug_tier":"Tier 3","prior_authorization":[{"prior_authorization_required":true,"prior_authorization_group":"Yes"}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":true,"quantity_limit_amount":"84","quantity_limit_days":"28"}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":false,"specialty":false,"generic_available":false,"maintenance":false,"strength":"40","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet","multisource_indicator":"N","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010001830","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Stomach Relief Plus Suspension 525 MG/15ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"525","strength_unit_of_measure":"MG/15ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010001805","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Stomach Relief Suspension 527 MG/30ML Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"527","strength_unit_of_measure":"MG/30ML","route":"Oral","dose_form":"Suspension","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"47300010000507","therapeutic_category":"Antidiarrheal/Probiotic Agents - Misc. (Medications to help control diarrhea)","therapeutic_class":"Antidiarrheal/Probiotic Agents - Misc.","drug_name":"Stomach Relief Tablet Chewable 262 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"262","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Tablet Chewable","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"46500010300110","therapeutic_category":"LAXATIVES (Medications to treat constipation)","therapeutic_class":"Surfactant Laxatives","drug_name":"Stool Softener Capsule 100 MG Oral","drug_tier":"Tier 1","prior_authorization":[{"prior_authorization_required":false,"prior_authorization_group":null}],"step_therapy":[{"step_therapy_required":false,"step_therapy_type":null,"step_therapy_group":null,"step_therapy_step_number":"","step_therapy_group_2":null,"step_therapy_step_2_number":""}],"quantity_limit":[{"quantity_limit_required":false,"quantity_limit_amount":null,"quantity_limit_days":null}],"limited_access":false,"mail_only":false,"age_restriction":[{"age_restriction_required":false,"age_restriction_detail":null}],"gender_restriction":[{"gender_restriction_required":false,"gender_restriction_detail":null}],"over_the_counter":true,"specialty":false,"generic_available":true,"maintenance":false,"strength":"100","strength_unit_of_measure":"MG","route":"Oral","dose_form":"Capsule","multisource_indicator":"Y","prescriber_note":null,"protected_class":false,"emergency_fill":false},{"gpi":"12109904300320","therapeutic_category":"ANTIVIRALS (Medications to treat certain t